- <n . " - | vV, * % t) ■ «- ^
/,i ' fi'/ v . ,•., i'
* ' y . i; v / ' V/ '* * * ;•'• ' f
.•/... * ■ \
*u"~~ / - " ' ’ V . ,\ , w . ,yjj|
. <rl .-# / # ’ <&£•’>’ .' f*i\t ■ f'
7J&
V £V* 'i . r * ■ / . ■
§ •' : - W'm
lu; r
1 A? V a .■„. v
J.
'Vif?
• t | ■> y
> „ ■-} T ' 5 ‘ 1 • * 4* . .... *.. --jrr * m
• t *■■ i ry
ih „ _3a
•? ^
) : y-{. A.d'fvi'-i rj ! '/;■ /■! 'J;
rfm'':' , 'ifrc&y W$ ''
■ * ' . Vy • *-.*• 1 V* - J
1 o u %■ 1S> 4
)
... vMf
r r. \
♦ s •£./
A ^
% *K
S* 4 *
1 ' Y i f~~ }\ A
f. M.ih^-r'"- V •• A ;
S/LrO*fo l ^d • / •*•' .
_* /(y fi < <■
I ‘ / l*X& C&A^sfr 4'*' U ** '
L 44 .*&' pM^ A ‘
[-. / 4 ^ 1 r-n
%
■ t/ i \ l £
, /,.><■- .*" '.;
I ^iv <£»Jbk\l«. 7 '■ '’ ■ ^ '
.'■ J^.'| {IrClri, T+'t '
Xht
H /
i
i^A-v ^ v ' ■ 4 ■ g>£
,%(. /> t
■
V f c
yj' ^.< ’ 4 cA
■/ :
Entered, according to Act of Congiss, in the year 1843* by
THOMAS I>. MUTT.Rj M. D,
the Clerks 0/Jice of the District Court of:be United States in and for the
Eastern District of Pensylvania.
NOTE.
The classification adopted in my lectures differs materially
from that of any other surgeon, and its utility has been fully tested
for several years* It will be perceived that I arrange all the
subjects comprised in the course under six heads;
1, Under the firsts I include Inflammation , its products and
varieties, and Wounds .
-2* Under the second^ I shill consider all the diseases of the
different tissues and organs, commencing with the Bones, and
concluding with the Sldn,
3* Under the third, the viri^fis affections of Regions may be
considered*
4* The fourth division mmprehends all Tumours , whether
malignant or non-malignant.
5. In the fifth, the Diseases peculiar to Females will be
considered.
6* In the sixth, Amputation.
Thomas B, Matter-
244 Walnut Street.
Oct. 1, 1848.
\
*iJ*£ >yjt- v y a. /A «*~ -- • 4
w- {■-«<►•- £•' ^ •
e^V
7 ^ 4 L
?
' ^ <^v a
< r^ jp>
A- t «^_^, rf^ v-x_pu- <£*=y-
4/V — v ^4
4L. 0 ^ j£?5Lv^ ntf
^ t- ^<?^ w <r*-*~ 4? /f* #v-v f
56C <£?X-i <^C- 6
yfr {*> * ^ y
-rfrzz: 4vJO
u>
7* e^S /r^r^t+r
- ^
<rv*
V/-L
y
>
<- ^ / l t. f^JksC ^' * ±
L y -t<r^~-
^ A^y / /''t'^C •*- <
A /• — / <^rr.- - ^ /£ .
S^Ct- C// f}
?«!*■*■ oy / > ^
^ iSdS- * >- , nV^- ft^t- £‘Ct/4/%i -K JA
/ *- -'*'■ s*y, ,<* *~~/ t /^<- *-t_-
/ *-*^--i'-c.^ yO t>+*»i.'i—u4 ,
•.<■-*,• (*) c*--<~ t ft^G, —— 7fyct^£$4i &~*4
- ~%y ]} l. t'-*^*-C*J. V /aC.^ ;vfj/> *-^
' —• .') >W>‘' rf (, 4 ^ -
-$?W AW<
^ £sO fa r />Vi^A-
^ 2^T
r? ,
/</
^*7 t/j-r ^^4^r^ ^^-<s»4^7 l £&■/'( yy# J ^ ^
~^7t/v A-N-i !^''~nrie^rC*'r- ^vW y^Vt, £*~St***f (j?7l»** MSf S/^
y djl*-'?->~- r r.'l^ l }-U^Q~ '&/u~. y^^A-C- 2~
yj jr-7* . ^ ', 6* ti f i ^- / t /y /t > f <,
J*^/ f A /A^rX / if?* v /^ 4
I <C#~ /*-<- ’ > ^ ^
I /£>±~<-j _ ^ \J£/ y y <564 Jt'-'/ fa--/$'.
I j£ : f±»+m jC-0-mQ w*. ««/ ^v.4. - *-^ ^* “ ^ ^ ■'^'‘•J -
* V
! t+jkUr*M 40
» A'T&t*. * - , , v ,.. -> „--... >VJ . t ■
^V y .*7 < 'r.-/ t c i: _ i
-&~y ^ i §lw^^ C / fv> *? /- ^ j
/*-*<])(y Tx. i- l-*~ t)
r^itc^. # ,/&.::•• I
\dL-/£e+„ s y*.
'-4*<t-</ ^3 *tsC+'\,.i*s4 fa ^ f .-: 'T
w-e- / / ( < • <^ / . - '^JT
/ yC' /fa jt , , y —^ «^v. ;<
y^e.* i, /• /// V >v J. *i~*.
Jkf- (C a ? <. &' /'/- •
r -Xy, _. •-■/
/-!+ •/ /'*./+ A £*- t *Ct^t * v/ ■£_. f 4'i t *cr ^j^
f*L*s^y^~y- r /t • * rs ^ , ^ w^>y, ; /^t< ^ t:
/ f ^4^* ^ ^ ^ *$ * V ^ / v
K >^ /a/ ^ *v- ■&'/<-'{*■>-y.-- • -•- " : S
xf 4 > n'Vv^ t^w-v<3 ^| V (^ t . w'f s f-'V-/ f*
IP>A jp ^ /c ^ __ ^ ^ _
(U l I t’-z-Gy bO hf krtCtb
f Jy 0V^O J ia^ |VMrri-b.L<|^r* "A-"-a
\ u - i- t e ^ f T* ^ V ^ v V ^
. • ^ yc,4. £y (~ @u^C' j /--
V t'
r ^ ^ Aw /* ^V/ »' ■'^ V /J t
f'U w ^ pfc^-C' /:■; / (j
Lm £ ^ ^ ^ 1 " *
> \ C.-
2# /
3tf r
■i
; 6 3f .C a^r-
0tu2
17
Iv^c*
i
/ ^ ^ ^ ls*^ &&$~C t*" /*!*» 'Tl^w^ f T <^/
/ i '# , :^' •„— {\rP--f m kv -£c ^9 Y^\^. l^c l\^s<-*C)
^ .- t/ L/ /^Tv-v *• ^ q, -*l—~ ,
'^^■•'y&,*.v /' ‘" f 5 t » V <'.•/•■' '.-■ '..,■ .-s '
■«■ <t~
^. ir
/?^v- ^/
A****' ■ ' ?' Y"~ £ ^
*WV^P*>
J' n ■ "/ >>-* '%tt? */■-*£> '
C'Yj-Jl ; ', ^U, ^A'siw.-^V is/
m ^v/*£L£^ tWr •
<?v
CjJytS*^—
*l4'
y/Ti^r^i'
x 6 r ~ ' : >' i HU
^ lL " Jr ^
iy*'* vrrjp7-\ jf 5 ^!
^ ; v ■ ^ ‘ h
/j •V-.- . V ? >; > *■ t*L >
v , | ag^^-gsu^ — ^-> t
< > <*■ i ? y /«♦-*.-> -*.. ‘ *- ■**?- k
/- -' / tr '*- ‘ j 1 '; /
" f ~-*r- w
& sZ-tc-
Cn r^fcYv <7^
t^-r'
-• v-lC- —a^a-j ^y,
Jlt'^-~ — t AhK.r/fo-'
c «_ o/-^*
& tv *!<-^ <- .y 1.
O^w ^JSC-v»w
ls-^-
sfcs-
yts'L. ^ v
,7
y
f~ ' *" 4 Awe" /
"J f v‘ y J *y &•£*— J&e>.£-p y
4f {.ivU^’k^tvtY tffk'
^ 4i-o. <^y f /uA^ 1 c -^
l /Tj V^v ^
/
<Ki?Yvvt<
4L-o
tv-U-^
Q.. CtA^*
juv^r ^y
liAtuV,
-C (V_
^'■Vy^ 1 T-i f/fn-vTt^Wk
^
’u*> iH^A^ n ^
/ # I /
, \ * ^ CV-
wwv^ ^ r
■*• . _._
j ■* —~ 7
sC l-kts rfbo*4& /
,jb ctyC^ J~ &
/l if'ft t—"' 40r~
d.
i'Utu*' *z 4/&*~ *
£,..> t,
• ^yr<fc ■-- - . /^
/vtj*-**- •^>/?^ , V' 4***—
, yT / ' <?
/-"/ V - - f - G*Hs**^
\+
/ h^> / }
// &,4;/) &c>£+~c*~ 6*
* « c_ /?
*4%
£^—■■ fa4*-+~ 0 T j£tft£s c
j/L js- - '
//" r ^ ,v/ (? j A^ufp^ t j. i^tif*
|/4 | t,. /uu ^ ()
/u W w ^' K ^
uC^~ — 0 ^W iL a £ z - 4 <X a - l r ^
/l^^vdO ^ "HV1/^“ .'Ci T ^/
^ ^ V /- > 1
VU/V irf-t^j tsV^i c/t’ 4u^w> ^Vw Ha-t/v *" U
Ct/^ ^ //Kv-C- li/-i PvC' 4| Z^'VyV t ^(_ .
4%
/
J
/^r-'
£PL^L~t r -i^- ^ Wj
. -e _
fpy-a^^ ^ /-w 1 ' ^ ^ ^ ; ^*„.,.
- J r ^ y-1. ■» gL. t _^)
^* r ****r-$^ ££**&&**' €ltf f A J
P^L.'
**<~cs A^4r ^ Ct^ asC,^] s
P4W'/)f
£Vi * fc-w..
0 * ipi C. - 4^ ^ _)
^Sp*+ ry ~*^ ^Vv-r «g£?£^# >/U_2 ^‘" <? - ^t£?
SYLLABUS OF LECTURES
INFLAMMATION.
Definition.
Liability of tissues to undergo inflammation.—S ome more liable than
others* Some never attacked* Certain of the lower order of animals are sup¬
posed to be exempt from this action. Not as yet positively ascertained.
Division oh classification* First-1. Acute* 2. Chronic* 3. Latent.
Second.—1* Healthy* 2* Unhealthy.
Third.—1. Adhesive. 2. (Edematous. 3* Erysipelatous. 4. Gangrenous.
5, Specific. {Hunter’s.)
Fourth.—1, Phlogosis. 2* Epiphlogosis* 3. Metaphlogoais. 4. Hyperphlo-
gosis* (Lobstein’s.)
Symptoms.— 1* Local. 2. Sympathetic, general, or constitutional.
(1.) Redness , heal, sitteUing^ pain, throbbing, and an alteration or suspension
of the natural secretions of the part* Although these symptoms are usually
present, inflammation may exist without their development* Cite cases.
(X.) Const itut to rial sy jnpto ms.
Theories of inflammation.
Effects on the blood.
Terminations of inflammation.™!. Resolution* 2. Delitescence. 3. Me¬
tastasis.
Effects or products.—!. Effusion of serum. 2. Effusion of lymph. 3. Ad*
hesiou. 4. Hardening. 5. Softening. 6. Atrophy. 7. Hypertrophy. 8. Che-
mdsis. 9. Suppuration, 10* Ulceration. 11. Gangrene and mortification*
Causes of inflammation- — two classes. 1 . Constitutional. 2. Local.
First Tlead } or Constitutionals 1. Plethora. 2. Local determinations.
3. Fever. 4. Diathesis. 5, Disordered state of function. 6. Suppression of
natural discharges. 7. Atmospheric vicissitudes.
Second Head, or Local.* —1. Those which produce palpable injury to organi¬
zation — as mechanical injuries of every kind—mineral irritants—-heat, friction,
extreme cold, &c.
2* Those which operate through the sentient extremities of the s verves- — as
concussion, pressure, constriction, irritating substances, as mustard, cantha-
rides, &c.
3. Fluids which produce a peculiar impression and gi/ve rise to a specific
action or i njl a mm afio ? i —a $ decomposed animal matter, pus or serum from
specific diseases* The most familiar examples of the operation of this class are,
dissecting wounds, pus tide ntaligne, and glanders.
\
( 6 )J
4* Those which suddenly change the natural feelings of the parts* For
example, drawing off the water in dropsy will cause inflammation of the serous
cavity in which it has been collected. Peritonitis frequently comes on after the
delivery; cystitis after the operation for stone, &c*
Diagnosis*
Prognosis.
Treatment.—N umerous indications are presented, most of which require to
be fulfilled in nearly every case. They are modified of course by the pecu¬
liarities of the attack, the age, and the strength of the patient, &c*
1. We must endeavor to remove the cause* An exception to this rule is
occasionally met with in surgery, when bullets, &e. lodge deeply*
2. We must diminish the action of the heart by nauseants, digitalis, general
and local abstraction of blood, by venesection, arteriotomy, scarification, cups,
and leeches.
3* We most reduce the sensibility of the part, and if possible cause constric¬
tion of its vessels, by cold—ice, irrigation, immersion.
4, When cold fails to reduce sensibility, apply steam, fomentations, poultices,
warm water dressings, immersion in warm water, &e.
5. We must restore the secretions, if possible, by diaphoretics, mercury,
iodine, warm baths, &c.
6* We must remove the original disease by counter-irritation, especially when
it becomes chronic* For this we use Irritating lotions, blisters, sinapisms, tart,
antim., croton oil, issues, seatons, and moxas.
7. When the vessels are turgid, we must cause their contraction by astringent
lotions, aided by scarifications, leeches, &c.
S* We must also prevent the afflux of blood into the part by position, fric¬
tions, and rest. Fres sure } recommended by some, is generally a painful remedy,
except in chronic cases.
9. We must always bear in mind the Influence of the mind upon the body,
and endeavor to cheer up the patient by every possible means.
PRODUCTS OF INFLAMMATION-
I* SEROUS EFFUSION.
1. Nat ure- of this fluid.
2. Kind of inflammation usually producing it t
3. Time requisite for its separation.
4. Local phenomena*
5. Effects upon ftarts containing it and those in their vicinity.
6. Diagnosis .—May be confounded with dropsy arising from other causes*
7. Diseases produced by serous effusion.- —Hydrocephalus, hydrophthalmie,
hydrocele of the neck, hydrothorax, hydropericardium, ascites, ovarian dropsy,
oedema, anasarca, skin bind of children, hydrocele of the tunica vaginalis testis,
hydrarthus*
■A
, vt 0jt~c Ux*4a Jo^tyy^y j&/ujXZ^ts ./.
j[ 7^ 1 , a 5^* ^ 0^%Pt A yt *^<£t^r^i-'&
I j . v t Aj * O </ ^/
I y^&&***^*^^ /vv\ ^ ^A **■*•/lT i ^v> «- *j / V v <_^n uj ?
| u ufj&t r A/£ ?/*!!<?'&■ foC-h&'tfrYvv^
\ ? a* 4<-^> om t.^ /At *1 ii. ^
■ *-/, *&*$ I'&MA-t r ffl i ' r « >> + 1> /V A A 4
± i-i.- ■* v- s jf / / ■ ., . / r,
dh^^n £7 i i * *H^t4 ut /-
06*^ *%/±, +§t\s%tZ>+2* ^ 5V ™'^U *b ^ ff£ - “* + 4
■ “3$'* *** * f/ • ,■ :••- , </ ^ &'* v 4 ^ A.-/ •■ ■
HI fn/t C'^t Ji$£»**'+ A /''^C^i.-tdd K■+**+*& ' J $d*-*"**‘Lf Ji /\J4 i /,C * '• /' V ^ ■' v
I [ l? 4A ryy*±dMh dj ‘/la<l^ /^y ^ cj # * t Cr*£ *J
I ^ a£ck~/ /^ *zr,^ j( >u-Jtt //¥ fT« <sUd 4 #
j ^ L Ci^J J) 4 /l^y J t ^
: A_-tiV-*j j"
ttfrdv /f
f / A 3 £ /
l; lC *f, ^SAA^,/ 7 ^,, I£s*ctff* - tJL+* /S-jf ^ ' “
j/ fr>- £ *C*CL~ / J3{f c *
txA
; ^rJ-
, r 1
/ J / / / Jj 3 p/t /j , ’ 0 ^ i^ v tvr f-" 4 1 - ' ,L * J,i ^^^‘
7)t^ /»^*vja6.. *-* *-C~ty, . $■*' ■ ■* «fiUy <Jyp V^'.'^* ^
Jf k r) d*
A
* J A #>
,/UU uXtifvi^^
/
*** <''"’ <r0€i£■<£>{ A, ^ tZut*
j*: n fl \ " ^ ^_ y> r ^ r _
| ft** I M- fn66? £~c>m/ s'S «-~ ^^ 2^7 ^
/ /
, >
s*.&y /z«.~* tB^t^a^^) /%6?
to ^ '/a. <AT*J&, ^/.^j
^~' r ' ***** //,.^„ ^ 7&m^ ^7 ./ ^ A ,,.,
| A "r f ^W«y-7fc«erf J^-***®* i# iJPgre&yti.eset^, y^L.
/^far /^ / ^ /
/*T* ^, 7 /^'/4 «^«t-. i£>,</f<..^^ //’<.^,.
^„!--- ' /£z*^ * /;/,,,.
jr^cxc^t^ {Lth^s^ /^ J$C
#5 £*■
fj
r , ''j^t^j
^ ^ t -£^ ^C^v ^V?t^ //t //
^ ^ ^ rt
r r C ^ cx T Y
^ < ^ ^ j /^— ✓? /5tc />?
—- „ / .
‘^t-
•i^' ^^*i..
— X t
t -r. / .
/** ft t / f tZ < <« 0fj
r/4£+^ /U 6ft 66 -^W^#.^ <C /• ^ e&ztft^,
•A A* 1 *■=? ^ /■<**<-/?*+*<' trinity /3Ei
ttA
h
* G&t/i
A
A
C *3^ -
^-€>L^€/ {rt*/
7
&?i £r& g£*4l- A}£ > /%c z£ S** <y& €^/- S/ y&yc^p 2<
Jw JC^Actt &Ls &? /2 ^t& C^zAA *-* yA^p r {+ ** *zd$t *^py
G£j>-to. <r&xf? l**C cA e*c *ZAAk A &i
y y y Aa^ r AA &£<z <* / <" - r&> -f
/^f / L ^< z-) t/L~& A ffl* yr^cy^j^ iAcAy Ak^> Ace**, t/fua. //*it ^
zAc^c^ty &c ?* € *t j^t < * « AAc^c f & - ^Ayt*/A*LA^.A y c A A^ ^ Ac AjcJ I
J&U <Zu+ / f ,/^t- cc r/^c ,/ <? / /t ’ ^ ^ ^ '
c/t
^r AttAp/ jfa^tszipy - AAs€r/** J ^1
^ 4 Z 2 > <£* i^^cAA m** ^ +& <?/*+*<*
Z^/AAA^A^'<^ y ^ AvzAp &AAt*c*j * /jcyfcc*** iX €
| f*f ey f c <5* & /f c c ftr±i t£ - A/^c?J Att Az*y *t A
ff^c y tfcticA**, / ctAy A* dAy&* t *<- /fa A^cwy ?y * ^ 1
A^ci* test * /- €Z<-t tA r ^ f*€&A*tdA*y /Ac &c *** c' A
ly***' *csc /t /fc^z*^ J&c* z^^ccA/c*^ AA/<y £ a ** ’ tyAy/ c^-u azz
JjCtflc / /!<// ^* J ' C&i~~ C ^4C
, /Sfe***. s< t* *C /5Tc *v< Ca/<x^ <r«r d^e^^/ckci p * Cy/^ s/fs C
\ cZt^M- fa trft O ey t/' V? ^^tiraseCCL p -)«*, -_.
i^t-(_,C zz/ fCz- < *Z , jC-f &&*+• &*-*£*. fCe^ Czz **y:
| Zv% /i* s- •z A^t+w r /?CCC*x-tzC /*+ <pC #st &K.&C, &**. & zrCsemi
I &z^' ~S- A-&&£y /^r £$& A&f^f A *-y 4 s£ C +l &/lc / ft'^c JZ <~ iC-S r
A /; IC C* S y tlepy^C C^/A ^ ^ /ft* ^ A S? * &
. /^£. j. f A*cZ <?-* s cZcp£*c At- A A c*^?
A ^ €c*ts?~ r?yc^-c^c- y
y c/ ^ c^ *^c y yA ^ Ay * , V ^ ^ /^A
I yffri /t cc*^ y? £+y[?ctL<- cA At**** c\ t
r c/ /zec/ctA* * ? Ayys&* ma^&u - yA***^c*^ Ap
/ ( AA 4 ■?/*• <^~-' ^ i -^. a '^**' t ^
ZzC/t-Pf J n *■&' £Z&4'C, r£. tZ&A- &■ GGn/tz&<0 Z'tZZcs .y -’**
// 7 • / ^ /
jZi'vfov £* ^ */ C&*- SH.&/C , *f'i *< , ft c<x-tj<~
s 7t-^ 7. '/iC ,'tf /- ^-c-
F Ji*£"***>
/ J%i+I*.fh tt*£i, aMp fifcc //St</J^
cJumt /tuAi*,A 4 y! *ns£r
&e*a*sz^ cSj, e+sasfa,, jk ,,
/i f ^try~rru /tArr/s^-d 01 , d*x, />&
£*J~/l&& {“ £7 < ^V 4^" 4^- K_ £2(3 ^
&s+*^aA ^ <^> <V /5fc>
jU^H^^Clpp A^cSfs £k*U^t, /-'^ SZ
JdyAAy ytdSjrr^) &d*) ,^~c t ^_ S', *-i,x €gC-PZ fv
j!yt!.i£, V, 7V‘ifit,uuA CwjuMti. dLt\,^ f 0ytf,ite3.3cZ+tn>A, ■*.." „ 0H.-M,-'
Ajf jU£<*+**s «g ^Ctj^ ^
^/ap*n*x; to ^
'AAtx- <xfz:,^ . *J_ ./fry ,,, // ry A^b tXu^,ad £ d^
^A/ /y**- f ti:-<.-* *- f 0>p.B&*d<y &t^£l r
^ Xi‘« A»j,ti^ fj^ y
A t’< l-1-C Ay s-n<r„<< O .J 0^,Cju*,^4jT fi'dj /»» ,/^uttJS*,
ufccA, a^Xj d^y 0t- ilno^A^dtdLyt^f*p r tn^ydA&r
/&V4*c&, CdcJ*, ^e'#n*j ,i t it -,j- £ld?4rr&- 0 C, -tlx csts f, r.y-
j&~$M /?t*adt4y*sC CW-c O^'t-pOL./d-fy,^ tf t^sfi,jt-yssz*> Afc- ts/s,
/ £-+■ "^-’ ^/l*-<Xi^- /A*.. c> ^< « -« 4 <JV
» , Ci^CD. / /
'*idc^ , / pAr ** 3^^-u- /^c- asfeg £7^ >< <9» t *
*"* 6- am ~ A*~*. j\
I /// * ‘ W : .-Wu^
1^L tsycA^. ^ jL £
^ •£* rv>L a^o t«i^j ^ %AA-*.a- \fy
ytlul A * *
V
8. Operations required to relieve these affections,
(1-) Paracentesis capitis, in hydrocephalus,
(2.) Paracentesis oculi, in hydrophthalmia.
(30 Tracheotomy, In oedema of the glottis,
(40 Paracentesis colli,, in hydrocele of the neck,
(50 Paracentesis thoracis, in hydrothorax and hydropericardium.
(G.) Paracentesis abdominis, in ascites and ovarian dropsy.
(7.) Paracentesis scroti, in hydrocele of the tunica vaginalis testis.
(SO Paracentesis articuU, in hydrarthui.
2. Kind of inflammation producing its sep at a t i on . — -Must not be too high or
we have pus ; nor must it be of too low a grade. There is evidently a secreting
pom*
4, Tissues in which it is most Halle to occur* ■
5, Effects upon the part into or upon which it is thrown.
0. Stages through which the lymph passes in its organization*
7. Diseases resulting from this effusion.— Hepatization of the lung; corneal
speck ; various tumours ; the hardness about boils and erysipelas * elephantiasis ■
closure of the trachea in croup ; strictures; adhesions; and strangulations.
8. Operations required to relieve the ^^.—Extirpation of various tumours ;
amputation of a» limb ■ tracheotomy or bronehotomy in croup; the different
operations for strictures ; separation of adhesions as in atresia vaginae; operation
for hernia.
III. ADHESION
Definition.—TY& accidental or abnormal union of <parts, either separated
naturally or by some chance, from each other.
Nature of this process .—This product of inflammation, or according to some,
of irritation , is nothing more than the effusion of coagulable lymph or plasma,
under peculiar circumstances. When, for instance, a simple cut or wound unites,
without suppuration, the bond of union is either pure coagulable lymph or the
fib line of the blood ; and it is said to. lical by adhesion , or by “ adhesive in flam-
nmtionf pr the “first intention of Rapier” Professor M’Cartney calls this
process ^mediate union by lymph,” and denies the existence of inflammation
in its accomplishment.
Theories in relation to this process.— Hunter’s ; Thomson’s; John Eelhs :
Maunoir’s; Delpech’s; Serre’s; DuhamePs ; those of the Physiological school, &c
Changes which take place during the organization of the bond of union.
1. Coagulation; 2, change itS color; 3, formation of vessels; 4, increase of
firing ess ; 5, conversion into fibrous or cellular tissue.
Process of vascularizalion .— Theories of Hunter 0Duham el, Clanny, Sir E.
Home, Gendrin, Laennec, &c.
Appearance of cicatrix.
Utility of this process —-Exhibited in the adhesion of wounds. The attach¬
ment of the lungs to the ribs m pleurisy. The cure of hydroceles, cysts, anti
' fistula;, ■ The cure of wounds about the abdomen. The arrestation of hemor¬
rhages. The restoration of parts entirely separated from the body. And the
success of plastic surgery.
( 8 )
PLASTIC SURGERY,
Definition*
Synonyms #* — Autoplastic surgery ; anaplastic surgery ; animat grafting ;
chirurgia curtorum per insitionem ; morioplasty; heteroplasty; taliacotian ope¬
ration, &e.
History.
Indications for the employment of plastic surgery.
Circumstances which favor the success of the operation.
Circumstances which forbid it# employment.
Result of these operations.^ 1. Favorable, 2. Unfavorable,
Treatment after a plastic operation.
Classification .—Several general groups. 1. Operation intended to restore
parts either entirely or partially separated from their original connection.
2. Operations intended to restore lost organs by a process similar to vege¬
table grafting, and hence called the (C operation by transplantation^ The new
Hap is here entirely detached from its original position.
3. The operation by <i transposition;' 1 the Hap is here left attached by a
pedicle, and is taken from parts either in the vicinity or at some distance from
the seat of disease.
Under each of these general heads are ranged the different special methods
of performing the different plastic operations. Under the first, we have the
operation after cancer, the removal of cicatrices, the loss of finger s,&£. Under
the second, the operations by « migration of the Jlapf « detachment and®a%?v*-
tionfi &c . Under the third, the operations by « glissement du lamhcau , or slid¬
ing the fiapfi ^Roulement, or rolling the jlapf ^ inversion of the flapf &c, &e.
PLASTIC OPERATIONS,
Each of these takes its name from the part to be restored.
1. Cranioplasty, or restoration of the soft parts and hones of the head.
2. Otoplasty, or restoration of the ear.
3. Rhinoplasty, or restoration of the nose.
4- Blepherophsty, or restoration of the lids.
5, Keratoplasty, or restoration of the cornea.
6, Cheilopfasty, or restoration of the lips,
?< Genioplasty, or restoration of the checks.
S. Staphyloplasty, or closure of the soft palate.
9. Palatoplasty, or closure of the palatine vault.
10. Bronehoplasty, or closure of the larynx or trachea.
11. Urethroplasty, or restoration of the urethra.
12. Oscheoplasty, or restoration of the scrotum.
13. Cystoplasty, or restoration of the bladder.
14. Enteroplasty, or inspiration of a bowel. ’*
15. Elytroplasty, or restoration of the vagina In vesico-vaginal, or recto*
vaginal fistula.
10. Plastic operations for the restoration of parts about the thorax and abdo¬
men.
17, Plastic operations after the removal of cicatrices.
IS. Plastic operation for the cure of hernia.
__
I V '/i/a v//en f tr cZ*
^ */ Cs£t&&*$L& ^ p~
$~y^tj&**Sr fr**r ^fe t /~
£**-£&l ^
^ ^ ^ * y—^ ^
^ 1 / <"/i Ci *- /^**« <^
/&^ 4 t*^ 4 ^<^**. (r//^ ty ^^
/t Cd4**s ^ ^zy/
X^-^, /v/a &£dr>zj0~</ztf r
0*<-^ X^ m^Xn 0^6 .* — ^*A
^ ^X<r
/> / J <V- {
'.V ^V^sU^V wj
^1' t^> ^tt~^fcj > J L&fvk'
IV. HARDENING.
Definition. ^
Cafcjps.-— Besides inflammation, it may result from natural causes, or it may *
be produced by simple congestion ; undue accumulation in the cavities of organs
hypertrophy; Joss of the fluids of an organ ; interstitial deposits, and the presence
of unorganized masses, as tubercles, &c, *
Manner in which inflammation produce# hardening, ■■ < i i * t ■ • J <^U,|
Tissues liable. *' ; J *
Effect on organs.
Treatment,
V. SOFTENING, OR RAM0LL7SSEMENT. ■
Definition,
Causes .—Usually from inflammation. May result from defective nutrition ;
disease of arteries ; want of proper food j altered qualities of the blood, &c,;^
the solvent qualities of the gastric juice.
is of the
Tissues liable to it. f /l
Effects 071 orgatis.
Treatment.
W Cat
VI. ATROPHY.
Definition. ■' • y
Causes. —Besides inRdmmation, it may result from a law of nature t as in the
wasting of the thymus gland ; an arrest of the nutritive process before biritHjfc
from a state of inaction ; loss of nervous power ; pressure ; diseases of variojfo
kinds.
Dtfiutffa,—Partial and general.
Effect on bulk of organs. —May exist without any positive loss of size, as in
eccentric atrophy of the heart, &c.
Effect on function of organs. \
Tissues mast liable to be attacked ,
Treatment. ^
VII. HYPERTROPHY.
Definition.
Causes. —More active nutrition in a part, dependent often on iriflammatio^
but also the result of other causes—as exercise ; vicarious function ; excessive
or unusual exertion in the involuntary muscles. It may also be congenital. ^
Certain climates and trades also predispose to its occurrence. Castration and
excision of the ovaries will cause hypertrophy. %
Division .—Partial or general, *#
Effect oft bulk of orgenzs. —May exist without positive enlargement. Cit A
examples of this.
Effect on function of organs.
Tissues most liable.
Treatment.
VIII. CHEMOSIS.
Definition.
Causes. —Acute inflammation.
Symptoms,
Tissues most liable.
Prognosis.
Treatment ,
'to
J —
,/hif"t
't.£-.^ gxJ' ^iu i
&Ufrvi?H* A 2k £ £5
> A
trtrt t.^jj.
- ‘ IX» SUPPURATION. .. ,0,-^7
^ SeM^on*/lAf.l A Jfk/f^ £h£ *£,. r* % > £** &
j C*««*._Iavam% tfc restflt of inflammation/ This Is doubted by some,
W~ * llt without foundation. The inflammation must not run too high, for hero, as
m the secretions, there is a « secreting or rather suppurating point” above or
below which pus will not be formed.
M Situations in which it is formed.— 1. Upon exposed inflamed surfaces, as
the skin, mucous membrane, &c.
2. Upon unexposed surfaces, as serous membranes, cellular membrane, &c ;
here called « purulent effusip
3 s On granulations. ,
4. In a sac, to which we apply the term abscess.
f>. It may be diffused through the whole substance of an orean. 1
J Time required for its occurrence.— Varies ftom thirty-five minutes yp to
several hours, or weeks. Jh,
£ Symptoms.— 1 . Local 3. Constiflfe W!^ f /? h\ \ d:i ' ; - M ■
Theories relative to tkm formation of pus. Numerous' Those of Hlppocr^s"' '
and Galen, Boerhaave, Hoffman, Stuart, Hunter, Simpson, Morgan, Gendrim
Carswell, Gulliver, Bonne, Andra.1, and Gerber, explained.
Usual change in tissue before pus is formed.^ Puogenic membrane of Hunter.
\sew gland of Simpson ; not always present; usually exists in abscess,
^ li?r I wo kinds ; healthy or laudable , and unhealthy.
V* 1. Physical properties of healthy pus.— Colour, smell, consistence, taste,
spec me gravity.
Microscopic examination of.- Two parts, solid and fluid. Solid composed
o, pus globules, and jms molecules. Difference between these and globules of
blood-
/ Chemical analysis of.
& Tendency to putrefaction .
d floral kinds of unhealthy pns.—(L.) Ichorous pus. <2.) San iocs pus.
t3.) Creamy pus. ( 4.) Curdy pus. (5.) Slimy pus. ( e.) Serous pus. n.) Sordes.
(S.) Malignant pus, (9.) Contagious pus.
M Character of pus modified by cause and surfaces secreting it.
Jr Action of pits on ike surface secreting it.
$ . May be confounded with mucus. The various tests examined.
Also with tuberculous matter.
# Prognosis.— Depends on extent and location of deposit©, &c.
Treatment.— General principles laid down. Modified by circumstances.
I. Local remedies, 2. Constitutional.
ABSCESS.
Definition..—A. collection of pus in au accidental or preternatural cavity.
When pus is collected in a natural cavity, it is called an « effusion"
Causes — Always the result of inflammation ; theory of Dehaen no longer
maintained.
Classification. 1. Old arrangement into “acute or hot,” and "cold or
chronic f no longer retained by most authorities.
2. Abscess of debility y or asthenic abscess.
d. Purulent deposit t or abscess ly congestion,
4. Metastatic abscess.
\
'UiaJubo,
frud- t&u* ia
£4//£t&£w~
/ ' / B *X
^rn^rz*^ $hi? 4^cf &£&?€^ tfj
—
/to
edL- tff
/ , /
&& £*^<f -
*/, /t/^i^C ^ ^ *»«*£. C^ ^<5
J?gl+<^ ^5fe +y^*&
^V' 1
?7£ ^Z^"? K M '
^ z /v r s\,*J
//£* , Jl£tM^yA+<s* frf pf ^+r&£ \
^ st **^ dL*^**} ^^*ne£ ^ sH%*^ *& jf/*u*^ &
y/~* <^0ZZZ. f
fc^*^ fiTy ^ 1 / - ^<7^ ^9^^444.
/>t/C r ^L*?
4**Lsl^- <rC ^^<7~
y6^<^ *^£jr£i^£t- £t^,d &£<&& $uiyz<*<#
—- -
4
mt’&r'***> /&'*r±o£C ^fl^<LsCfiCZ^ 4 v%s£*.
/^*v^ /»v ^ ^ / n t /~A
/t^&*^r*4&-*»$- JlL^
/2+G*^ ^ ^ A^p#^*--
^ ^tc+-ri*£ /^..
^ Ay& c++s£s*^ r ifsn-ti tOp
A^wf/
yW- ^^tM^ 5 ^ €^C-
A*t &£**-&-$&* ACjM^e, f ^A ^ &ac^*J4
*^ZX A^^c, Id t+rCfa sfrSCl^ /*tZT
^KX 1 ^ ^ *** <g<^
tTi&t** £w^£, -, ■&£■ ZA 4&*+s
^<i*k^L& w $+ £tzz?£> jfczr
/#AAtZ /7
/m^ id^£-*^ #t ^ 2 *^aL 7"^/^
<*^ 6+*^2v, ^lt_
y&^ A^Aa* $z*~<) <^C<^ A^/ ^rC^TZ^ <AAfy^A^U+~ *
4f U* /frfc^v^ ,/W^yy Usw-jj-tAiJ^ l^/t^^Cy^ / ^ ^b^*T £-
^^fctvX/ fe^u. ^ci_. #L^ li4>L / Hx^v^ ifcttftfr
/Inii r)^>^tf4 : $ >feT p^r<3i^r^- flxr* Viv ^j^ti
U't tc pLr P'V- lw- &'"fr~*-j:*-
■
( 11 }
Some writers make a much greater variety* based upon cause, tissue, or
organ involved, &c.
Changes which take place in the tissues from the period of inflammation to
that of suppuration.
Changes that take place after this .- — Divided by some into three stages : 1st,
deposite of pus in the cells of the part; 2d, maturity, or the collection of this
fluid into one cavity \ 3d* resolution* either by absorption of the pus* or its
evacuation by an operation.
Structure of an absebtfs .—-Depends on its character. The puogenic mem¬
brane is usually, though not always* present*
Uses or functions of the cysts.
Mode of growth.
Direction of growth.
Progress of growth *.— Slow or rapid.
Termination —In resolution* ulceration* granulation and adhesion ; or it
may become encysted.
Effects of air when admitted into the cavity of an abscess.
Symptoms. —1. Local* 2, Constitutional*
Diagnosis*
Prognosis.
Effect on the constitution produced by suppression of the secretion.
Treatment ♦-—-1. Local remedies* 2, Constitutional*
ASTHENIC ABSCESS*
Peculiarities of this form of abscess explained.
PUUULEXT DEPOSITE, ETC*
Definition. —An abscess which differs from the ordinary forms in the cir¬
cumstance of its pus not being originally formed in the parts in which it is
found. It is hence sometimes called symptomatic abscess. Cite examples.
Why called abscess by congestion ?
Parts most liable to this form of abscess ,
Pathology.
Character of the pits.
Diagnosis.— Often obscure.
Progno sis Udually unfa vo u rable *
Treatment —- Depends somewhat on circumstances. Governed by genetal
principles. To illustrate more dearly the proper treatment speak of that form
called Psoas abscess*
METASTATIC ABSCESS*
Definition,- An abscess that suddenly forms without any previous indication ^
of inflammatory action, and in parts distant from the point in which suppuration
has originally existed. Hence it was supposed by some that the pus actually
changed its location* or that metastasis took place. i’
Location .—Usually in the viscera. Sometimes they are met with in the ^
cellular tissue* muscles, joints* &c. They generally select the largest viscera if
and those most highly organized. 4 ■
Number -Varies from one to several. |J
_ E^cihng causes.—Wounds, great surgical operations* injuries of the head^-'^
trivial wounds of veins in bad constitutions* delivery, t
( 12 )
Prozimgte cause . — A number of theories on this point; supposed by some to
be tubercles previously existing in the organs attacked, and softened by the
general irritation of the system ; by others, direct absorption of pus by the veins
or lymphatics, is considered the true cause ; others again refer it to sympathy;
but the doctrine now generally received, is that which considers the true cause
to reside in inflammation of the venou s capillary vessels or larger veins.
Condition of the organ in which or around which the abscess forms.
Symptoms —1* Constitutional, 2. Local. Both modified by the location of
the abscess.
Diagnosis. — Obscure. fJ-y L
Progu os is ,-— Getter ally unfavo urahle .
Treatment. —L General remedies. 2- Local remedies. Both modified by
circumstances.
FISTULA, OR SINUS.
Definition.
Causes. f ' 4
Symptoms. *■
gn,
■Ml aJL^
Pathology. K
.Diagnosis. /
rat ■■ .
Hs cn^ j-a • . ! J p , thl f ' 1 /,'V ^ x -t
1 M kfk «**- ' J
HECTIC FEVER.
Definition.
Causes —1, Constitutional. 2 , Local.
Symptoms .-—May be divided into three groups : I. Slight febrile action,
with exacerbations in the evening. 2. The febrile action is continued. 3. Pros-
tration indicated by perspiration, diarrhoea, marasmus, &c.
Diagnosis.
Prognosis
Treatment.
o 4 i
£. ULCERATION. viifii
Definition Different 1 y defined b}^ different authors. I adopt that of
Phillips : - Laceration is that product of inflammation in which there is a loss of
some part of the body, which from some peculiarity, local or general of the
constitution, manifests no tendency to heal, so long as that particular condition
exists. 15
/9 ^^pistinction between wounds mid ulcers.
J?- Predisposing or exciting causes of ulceration.-™-!* Constitutional. 2, Local.
„ Proximate cause. —.Difference of opinion among authors. Hunter's doctrine
of “ LIcerative absorption 15 explained. Difference between it and £i progressive
absorption. 1 ’
q Liability of tissues to ulceration. —The most highly organized, are most
0 frequently attacked. Some tissues are exempt.
Natural tendency of ulcer atio?i.«—N$ hen left to itself It generally extends .
Sometimes it heals sjwntmieously.
jy LjP c t> s of ulceration upon the part attacked , or upon the constitution.
Tissue forming the surface of an ulcer. —-Called a gran ulating surface.
/Ae^Cc^,^a.M^~r
£zp«snf &A> /bA****~- **+-*-^ .Adb+dA&*~~ A~&At*
pa*4- wA^cA* tffe'Oz** c- ^
faiit/t-'CC^nvt*4s c&
fiA**rA£) ^ ^ ty£e~o^* /
^I^Em’ u' Cm-^jC «»*-«)^*—^ Atatny Uf £
/^^hrrx** s/ /
u> 'PPulie**^^- <3
A*A&s?i**<fe_*6 s^ r ' aAc*^*? r^/la yb*(«<&<*.
Jb*~t rf s??u*-p,A*- &£•£** ^_cs iCc^ i^Cc
^ / -<y j ^5& ty%Us
&%€**-<- Akzzv, at ^fe [ ^ a ' A%~a :<
/i^y /&i4t*p.
4* srA~/%‘^ a~ * Aa r
( ct-SSa rtyj &&*i£ /
>»»^ CL f -2. A*S?.~ A<*y+-^y-
3&h- /"aa^A*- h/A t—- ^S»~t#’ ^ &< A<- 4~~a A
4f J$al Aa^o.*^ ^ hy &-&Ch*£ fly t*£i**^& td* *-*■'•- *-
m
'
-.***>5* -*A ^«V\ iN v*4fe, , «*
^ ^*&-‘>»H *^i C*m W**- \v V;
O I-rNitfc .'>V’^*» %~-N >.»*■ jS^ \ „?
*• »i!^JW »i' ■ * *•*»•£' V *2$V^ ^ '-.*, i -JO
; ^ v..^*a > \ ^ m\ ^ »%i^
'
N\ ^ ,
v •*- ** .»■*%»►
'-'-»% > a '*^*"^ >r -\ ( ^‘-'■ V ?S. « V-*--
‘ \
m
■'■s -
:
.
.
v ■ -m ‘ -rt NtSfj,J huf
m
4*Sirt+^mpC 0^. utJljL^^^
~~fikis**j a> Ou> jy^to %a*s k^cl^A^tu^u^ U
^jki^tit, nwvu^ Ut^J&Ajf by {\'ia^$e£^ ^ ^ oUl £l^L*^
‘j&i&A **\£4^* to fr&Ar ^i*r ^
jvrftiAAC^ tmifjfa^cJL' foUt !♦*» '*$uZd j\\*tr>buj£ <
Lu <U^(L^fe^'fcfcL ^tlt^
uM± tA
^fc?4^' *
<*£ fy(jUv*ya (Ty^aO-c ztJt t C *4ju
Al^±0t*y^ fi40\A±s. t IA1^ d^t t?Ev^ jfaoxjt; ^ (P^i^
tA^v t i(^ i/ (fiv&ir td&o ia+A^€*~ qs^£-
(Vu> jtA*^ 1 - us^ob*- fad* &tljU-JL<*-^ tuAttit v ^w
JLJn^eA^iM^A ^iu.JU- , J?4*_
id U/fl^W l#***^, (iH-tZXs tA- t^/ *y
vf-j (ifo- p &d*stz^
■fcrtlu Ltfd^i % n ^ ifeiv ^ £z34m^ (aa^&Ls *vvU
it ^ /v M^Ol, y jfi^f Os &M4AX,
" twA IAu^ i^/luAtu^ id 1*4^ ^.(IwiVtuj
tt££; *^j 4^ )LjJ
lSwf^^V v tfl ^UavUC ^lultty^
Ufr rrMO (All p2 lA-Ost,
C*wj\.iA-1 Qrl'J tr*/h
ft
0 ,
1/ryCf**u
13 )
^yc-v .
£^\ i / p'fa r b& Ql£ [ ~ ^
' V N ;,.A £o ris.^s<JO
GRANULATION*
Nature of gf&mlations, —1, basis or element of which they are formed;
2, size; 3, colour; 4, shape; 5, temperature; 6, organization, Gnterboch’s
/ statement as to what enters into the composition of a granulating surface,
Ag j Dependence of granulation upon suppuration*—^ Pus is supposed by some to
* be essential to the formation of granulations ; by others this Is doubted,
not found* for example, in ulcers of the cornea or cartilage.
It is
CICATRIZATION,
Cicatrization^ or the healing of granulating surfaces, L >
JL Definition of a cicatrix —Tissue by which a wound or ulcer is united. By
^Delpech it is called the “f nodular tissue”
Difference between cicatrix and the tissue it unites.
Modification —-This process is modified by a variety of circumstances ; for ifn
example—
1. When it occurs tinder a scab or crust of blood, the cicatrix forms over
the whole surface, and is smooth and pliant,
2. When it takes place on a smooth, moist surface, as when a wound heals
by the ** modelling process of M’Cartney,” the surface is smooth, and the cica¬
trix a mere line,
3. When it forms on granulations, the process usually commences at the edges
of the ulcer, and the surface is often irregular and prominent.
4. It is also much modified by the cause of ulceration. Those, for example,
produced by burns or scalds, are more irregular, have more extensive adhesions*
and cause more serious deformity, than when they result from any other cause.
#- Specific ulcers usually produce a characteristic cicatrix,
5. The character of a cicatrix is alio modified by the tissue in which it occurs.
Structure of cicatrice. * r ■ y / ■ 1 J ; ' ;; 1 ”• It ' > . t ■> < > ' - tf f t
Profundity or depth* ' h' i
Force with which it contracts during the process of formation.
Circumstances which prevent or retard cicatrization*
Nature of the tissue of a cicatrise,
^ Power of resisting disease , and 'diseases peculiar to the cicatrix, —Refer to
Mr. C. Hawkins for an excellent paper on Cancer of Cicatrices*
Form of cicatrix. Dupnytrends classification.
Prognosis as to the result of operatic ns .— Depends on a variety of circum¬
stances, We must take into consideration—1st, the depth of the cicatrix;
2d, its age ; 3d* its location ; 4th, its extent; 5th } its peculiar character ; Gth*
its vascularity; 7th, the condition of the parts in its vicinity; 8th, the health
of the patient.
if* Treatment of cicatrices. —-May be divided into—1, That proper during the
W* formation of the cicatrix* 2d, That required after its complete formation,
M Indications under first head. —1, Remove all agents calculated to prevent
cicatrization*
ft 2* Endeavour, as a general rule, to make the cicatrix as small as possible,
Jr unless by so doing we interfere with some function.
r 3 r Prevent the cicatrix being too small or too short, as in wounds about the
fingers, face, See,
4. By caustics or the knife prevent fungoid granulations.
fat
^ * *
t
i
/
( 14 )
4
Indications under the second head.— 1* Endeavour to relax the cicatrix by
frictions, baths, extension. &c. ^
2. When these means fail, perform an operation. The character of the ope- ^
ration is modified by circumstances. To render this part of the subject more
simple, the operation required in each form of cicatrix may be briefly referred to.
{!•) In the narrow cicatrix without extensive adhesions, divide the cicatrix, m
extend it, and maintain it extended for some time,
(2,) In the prominent cicatrix, slice it off, or keep it down with caustic?, or
slough it out- ' 1
(3.j In the cicatrix with extensive adhesions , cut out the cicatrix and fill im
the space with sound skin. The practice of Hildamis, Earle, &c., i„ these casA*
explained. »
{4.1 In contraction of natural openings. The operation of Dieffenbach. & c *
explained.
(0 ) When, an organ is entirely destroyed , the 'cicatrix must be removed,
n plastic operation performed*
Definition < — Solti11 0 n of continuity, accompanied by the secretion of pus or
other^ fluid—(Liston and S, Cooper.) A granulating surface secreting pus_
(A. Cooper.) This definition is objectionable, inasmuch as we may have sec re*
tion of pus without granulations. The definition of Liston and S. Cooper is
better.
Difference between ulceration and an ulcer.
Olassificmion.—Dildicolt. The causes, the symptoms, and the parts attacked,
have each been taken as the basis of a classification. That of Liston I prefer,
as being most simple. He makes six varieties of ulcer, and. in thistegrees with
Sir E, Lome. Their classifications are almost Identical*
1. The simple, healthy, or healing ulcer.
2. The weak or sluggish ulcer.
3. The indolent ulcer.
4. The irritable ulcer.
5. The specific ulcer.
6. The varicose.
i
SIMPLE ULCER*
Characteristics ,
Causes*
Class of persons usually affected.
Parts of the body attached.
Prognosis.
Treatment.
WEAK ULCER,
Characteristics.
Causes.
Class of persons usually affected.
Parts of the body usually attached.
Prognosis ,
Treatment.
V*
\
\
I
*
f^vZ Q^C^f^yL jppr i^\i L J!J- (X^ tx
£k±C^fg*df y^^.^L^y £*. tu_
jftSXi
cb^fcr
U «»•* **••*.
ji /~i -&‘ A'' f*' ft 'f
£^r j* ^ ^(" £f- * i'V- f t '* f ** ^'
/r j j <&..**'iST t; >.<Vv t» /»< /
y-/&*&' ' 4? i ^ / t* fix 4*4,1C- 'f C>t4*’ -jr \
IsJf^b' X' &*■*■&* '£^t/*Y*s{*---' *y
£) (s-'CA-fr ~fZZ C.O ^•■/hi., V-
'
.'>*■-
!
>
\
fa/rtaAq
vl 6 Ueu*i<^cisHiGL>&
'Sj.aM.IztfaffrjrfufaU d defy*
tA dtyinai AM&kfkp'fiiA' f j^rftMJM/xdf :
t - $%£fa*c -
;t>* iSiljko'h /&&<4 <*& fatty
(fcCMA.fr
tuftycJrtt* /jiAu '(/ (pka. A* cj tyfjrh!U/ii*u+
t- • '£*^/d-a/ntyfjfy dfa4%.r£8e*i<<f# / > %~h$^
i'sJhk
jsL$£j-u+dk+-
i&~; 'm $%zteQiA<Lt£C., a#
be HfdJjid(& 4. JUi$M£<zjc vfU- j (dL fautfa j pui
(a V c '*£ l^jj i" < 3 - ( IJ -
dr -ttvvO l*J iin-tAJL
(fc
( 15 )i
INDOLENT ULCER,
Characteristics,
Causes,
Class of persons usually affected.
Parts of the body usually attached.
Prognosis.
Treatment,
IRRITABLE ULCER*
Characteristics,
Causes.
Class of persons usually affect ed.
Parts of the body usually attached.
Prognosis,
Treatment.
SPECIFIC ULCER*
Characteristics,—De pend on cause.
Causes.. —Cancer's scrofula, fungus, scorbutus, syphilis, &c.
The peculiarities of these ulcers will be pointed out under the heads of their
ipective causes,
VARICOSE ULCER,
Character is tics .
Causes.
Class of persons usually affected.
Parts of the body usually attached.
Prognosis,
Treatment.
XL MORTIFICATION, OR SPHACELUS.
Definition.
Difference between gangrene and sphacelus.
Classification.- —Several terms are employed to designate the different groups
of phenomena which characterize mortification under different circumstances.
We have, for instance —-
1. Hot, acute, traumatic, or inflammatory mortification*
2. Cold, or that which takes place without previous inflammation.
3. Humid, or that accompanied by the effusion of fluids.
4. Dry, or that in which little or no secretion or effusion occurs. From the
. fact of its being chiefly confined to old persons it is often called tC Gangrene
Senilis, 31
5. Chronic, or that form described by Pott, as attacking' chiefly the ex¬
tremities.
6. Hospital gangrene.
7. Epidemic gangrene.
S. Specific gangrene- — example. Malignant pustule.
Causes .- — Yarious, It must be recollected that mortification may result
from many causes besides inflammation. Nearly all of these may be ranged
under four or five heads*
L It may be occasioned by any cause capable of producing a cessation, or
partial cessation, or even a feebleness of the circulation in a part—-as infiamma-
tksn, mechanical obstacles, debility, ossification of arteries, &c,
2* By any cause which occasions violent mechanical or chemical changes in
the part, as contusions, lacerations, heat, cold, mineral acids, and caustic alkalies.
3, By any which, in consequence of their poisonous properties, will produce
a deleterious influence upon the system at large, as the virus of rabid animals*
and poisonous reptiles, and animal fluids the result of decomposition.
4. By any that will impair the powers of nutrition, or furnish bad chyle*
High living, or had food, certain articles of food, (as ergot,) had air, had lodg¬
ing, and certain trades by obliging individuals to deny theipselves proper food,
air, and exercise, will all predispose to mortification, and may produce it with¬
out local injury*
b. By any that will cause intense passions or emotions of the mind. (^See
Langenbeck.)
, - Manner in which these various causes operate upon the parts attached.^
Liability of tissues to mortification — some more liable than others *
Time required for the process of mortification to be completed .- — Depend s or:
circumstances*
I* It may take place very slowly.
2, It may occur very rapidly.
3* It may be instantaneous.
Symptoms — 1* Const!tutional 2. Local
process of sloughing .^ When in consequence of our remedies or the vix
medicatrix natures, the progress of mortification is checked, a distinct hefUndary
hue is formed between the living and the dead tissue, and nature proceeds to
ampjttaM { as it were, the portion which has lost its vitality, by a process termed
u $totfgMVcgt' 3 an <l where the bones are concerned by li exfoliation fi the chief
agent in the accomplishment of which was called by Hunter “disjunctive
absorption f
The different changes which take place in this process described.
The period at which it occurs after mortification is completed depends, on
circumstances. State what these are* Condition of parts after the separation
of the slough, and their manner of healing.
Prognosis —The effect produced upon the system by the occurrence of mor¬
tification depends on the part involved. If the organ destroyed is one of import¬
ance, or vital, the death of the animal is either instantaneous or speedy. If, on
the other hand, the part affected is not essential to life, sloughing takes place
and the individual recovers. Sometimes, however, this process is so tedious,
and the parts destroyed so extensive, that death ensues in consequence of debi¬
lity and hectic fever. It is also modified by the kind of mortification present.
Diagnosis.— May be confounded with other discolorations of the skin. Posi¬
tive signs of mortification must always be present before we pronounce upon
the nature of the case. We must always be careful to ascertain the depth of the
slough ; ibr the skin alone may be affected, when there is every appearance of
the whole limb being involved*
Treatment -To prove of any advantage, so far as the affected part is con¬
cerned, our remedies must be applied in the stage of gangrene. They are also
modified by the varieties of gangrene, the general condition of the patient, the
character of the cause, See. We may, however, lay down certain general indi¬
cations to be observed in the management of all cases.
1* We must endeavour to apply such remedies as shall put a stop to the dis¬
ease in the stage of gangrene.
2. We must endeavor to arrest the progress of mortification when once formed,
and at the same time lessen the violence of the local and general symptoms.
'fy,
fmJmi' t4ra£$0t$% [udkdri. fiixA' IU*2 ttf*k ‘
Ma-ktiif jfy tft&c ^ x 4Jm^kt^:jl^)^U4^^b 4 )
tMwm
4d p$ in -i*
-iC%4j-£3c — /- •
vr „ w _ _ __ l$(0«4 £vyC<j (Kt^i
''•' e^tA^-Sx. e*& <<*£ iGmlJ-
Ji t. '4-\_ fat - o*&- •• V / •■■ *"' > -' /^L
G*$K !*•'?>■ # /& ^ ij'- ' y t,v-v ^ jl
!•/«■-
t ; ^ rf - rvy* A.-wf' VvV ^/« -' <M- r t/- A -' 'y kV -v N
. . “ _ i 43 /v. <x*/$u£- » •/ #£•/'? «-K £' £ \ *^**^1
^ iv^^. <34^* fad. 4-4 * <tfr-{*~4 /*VW j
_ „ _. ,W~y
-Jv cVhS
. y, .. j/ . *' ■ im m
gi. f'eT>n.*^ T^U’ «, ‘ 1 '^? es^.-h***-}
ji/faOh
, > 1 ■ t*-jj j!/'^ t A'/i ,' <£*-up ^
Ae^dc /4*-C*r*%*r ~^u2s < 1 ^
A Astvl s~A-s4 cs^^C- ~4^-0 i***<l'%j £ £/ *}/
6^vix px < £?_ @4?«w. -ffVt* '*- /-w ^ r ' - . 4-/1
fy’y&'tvj ." />i. J* c; <^’A'*'' /t^ A-." >< t-t'ts ~r]
J'A-it-** - -^ r A-°£ -v /; ." i f
A'J?<' j fidj- ,-c-t '* Mp/ /u£r&i£*i (
jTTL !}vAV^.~y ItUAi, - k i.W/U / vU5 ^
IV 4 . cdJU-j^., piiAMft~- ilrhy ^-Vy*
/{ iJ$$Wv «- jfa-'-V Av /C^'l-‘M/'*4' ? -'t> ^L-trv^ ./**£■
fW H - 'Vlvi^O' ^ -tvv^ ^mU/ P
>Jc fw jA^v^^ra fit, tv’VwvC-
?>iCt4-t{5 ^ kruwi^ _ ' ^ a
|\^w jtyv /1 (k-v.cU*r<’- U.fi* fr^A> ;.->■&*-*.
S&Ju*, ip kvt- / t • r> vi —' ^0
fit* tfi\ W. CfiLt> ~ , /lt :.-
$- vV J U TiX-vf «K t’C'-A
(' : 1tA yijC-U*QA. Wv y tr^uyL Jkt-ly*.
j^r};\SthL^ (Wt- T ^
>U^ V.v / . v .
/yi^ *a- yuAnn,,^ A fe-srr £-,**€ < ._
o. -; 5 »Eu, _ < 5 h- ^ ^
|y£y>v^ /&-/ (}^\ i£a 6^-W S
•^r^-W‘ ; //W ^ A e ££*& ““ v £ (
^ /W-ClSX-** *+@LJ -— /rtf-^Ur 4 ^ 1 A* *\—-~'£—
* faftu*- ' A^. «^**, tduufa- Zu, A**~&
A*^e> CaZAl &-&Z fl i-L.f) Qu-o&-/?0c £A"t* d-£
■t^ cLr&*.c V i e-i -AU
{ 17 )
^ 0 must favor the separation of the sloughy and when nature 1$ incompe¬
tent to the task we must effect it for her.
In obeying the first general indication, we must always take into consi¬
deration the cause of the attack, and remove it, if possible, at once. I f tnjlam-
is the cause, antiphlogistits, general as well as local, are to he employed.
It strangulation, or the arrestatipn of the circulation be the cause, the stricture
must be divided by an operation, or relaxed by nauseants, &c. When produced
bjr the binding of aponeurosis, or $Zin } as in carbuncle, free incisions are to be
made. When intense cold is the cause, the temperature of the part must be
gradually increased, and the subsequent inflammation treated on general princi¬
ples, he. The best local remedies as a general rule, in this stage, are cold and
astringent lotions , or warm fomentations, water dressings, or poultices. Leech* ■<
may also be occasionally employed.
/' In car rying out the second general indication, we must resort to both con¬
stitutional and local means. Tonics, as bark, wine, opium, a good diet, and
fresh air, will generally be required. The local remedies are incisions, (to be
used only when the tissues bind, or fluids are infiltrated to some extent,) blisters,
mt. argent., creosote, yeast or carrot poultices, chloride of soda, pyroligneous
acid, and carbonated water. Charcoal aud bark, once so highly esteemed are
not much employed at present.
The third general indication is answered by the application of warm dress¬
ings and poultices; removing the loose sloughs with the scissors and forceps
and by amputation.
Period at which amputation should be resorted to —-Depend on cause. In
traumatic mortification remove the limb as soon as possible. In all other cases
wait until the tl red line of demarcation 77 is formed.
Point at which amputation should be performed.
In this stage it is usually necessary to support the constitution of the patient.
There are certain kinds of mortification which, from their peculiarities,
deserve a separate notice. The first of these is
DRY GANGRENE*
Dcfmtion.
Syno?iymes —Gangrene senilis—gangrene of the rich.
Persons most liable -The old and dissipated* Men are more frequently
attacked than females.
Causes -Divided by Francois into two classes,
1 + Those which operate through the medium of the vascular system, as in¬
flammation of the vessels, formation of clots in their cavities, obliteration of
vessels, ossification of arteries, diseases of the heart, diseases of the blood from
had food, as ergotted grain, he., and mechanical injuries which obliterate vessels.
2, Those which produce their effect in consequence ff either local or general
debility of the nervous system, as palsy, old age, and the excessive debility of
certain diseases, particularly phthisis pulmonaiis.
Symptoms. —1. Constitutional* 2. Local When ergot is the cause, the.
attack may commence with convulsions of the limbs and vertigo, or it may
begin with the usual local symptoms of dry gangrene from other causes. The
former was called by Linnaeus « convulsio eerealis,” and by Wepfer, *‘cormiI-
sio ab ustaligine.** The latter, o necrosis ustilagmea," by Sauvages,
Progm .* is .—Usually uufavourable.
Diagnosis.*—M&y be imitated by malingerers.
Pathology —Still a matter of dispute. Cite the different views of Belpech.
Croveilhier, Dupuytren> Tbuillier, Tessier, &c.
Treatment, —1. Constitutional. 2. Local,
INFANTILE GANOHENE.
Definition.
Persons liable.
Parts usually attached.
Causes —Question of its contagiousness*
Symptoms.
Prognosis.
Diagnosis *
Treatment.
CHRONIC MOUT IF LC ATI ON*
Definition,
Persons most liable.
Causes.
Symptoms.
Prognosis.
Diagnosis.
Treatment.
HOSPITAL GANGRENE.
Definition.
Synonymes —Phagedena gangrenae; putrid or malignant ulcer; hospital
sore ; gangrena contagiosa.
Causes.
Symptoms.
Prognosis,
Diagnosis.
Pathology.
Treatme?tt.
MALIGNANT PUSTULE OR CHARRON.
Definition.
Causes.
Symptoms*
Prognosis.
Diagnosis.
Treatment*
% -
VARIETIES OF INFLAMMATION.
ERYSIPELAS.
Definition.. —A peculiar form of inflammation attaching the skin and mucous
membranes, taking its name from two Greek words which signify red and skin.
It is also called St. Anthony's lire.
43
d#vvt !
~ ^ -Av>^ (jfrTjb-u) $h<h± iil£u£
1 ^ ^ fovvnv h mfW
- /? Uev‘4 i/*M‘ >wf^T3 Liable /tZT
’ y w ^v-i^ h* ^ «-?_ x^u' p-xA&JL' p ci^i
fisd*hr C<j h £/ 0%i^4j^ ii^hj frVyy &^MjL
fy ^ ///btrt 2 ^/ U/t'iC ~7CZ /j*> t L r , /(^r’j-* J _
d'“ , lUnjL^Z^ ^y cjZir^V &, M'lr Xs j*. a 4 -
/ •* ,W iifady ~#*U- ITT* t+'f, A? Qo
Jd4*r'^ li^n^ Jh c * t C*Aj, llu ^U*sk tA/f&i, hi*£ l/C
y^ */ Awfo*, $ /a*£~ $tis £u/& k /
4 &J ^0hx4 JtzAZ**^ ^C rx zjL- v htrx^{ *~£Z ,
P- fib 4 Snjpr'J?^ £0y»J) qM hi <c-4/t~"
jr/zu) j4wt c ki ^i^h
,<Y?JrcQ>l- — /tjf zhua-. ij V /yt-'dfrx^ij -
t IK* tfja ' “' ■ K
r
^ Hv £;
/kvw i
tv V-' l ^C^}<Jj
4
r c4r s
tfv-o
^ iv vai.
. /z4/*4 A
TT)yy «c.w ^itv /f4 I tC-Hwi ^£#hJ /C 1 v •:'-
^ ^rfi^uh^ h hi/'kc * Ced" i*y {U-tejC'S^ ^M* A
ft||w A^Tx/^ 'cX a ^^ulvtw _ iw^ii ^l4% ] yfciLs ju
||^ l^rwtAv k4ow "|^>L v4 w hhh^ **&£*< \£ ■/*■ <-■' lt<sV
]v—■
/ ’-*s
/Sf
cutaC^
f-uy^ Op- 1 ^/;}r-u ^
usvKT -- „ r
kq. {&- (Pi^k iu ^i^'Uu4( a>*A
'■ Lj 1\ajl$J f ,\ kA.tf I As IaA 1 .1 yy ■., ,* . /^_
f'H- *£$U *-
4 ;< I,
Juj*- lj 4«-tuiU*t ldfS*4 t)j j* Ulr
^K$>6*Up _ &„v4 u< 'Obit.,. ..
ilpvfrfcd £ct{t£iyC yn IVTfa jh & ■J'jfcJL Qu*t^ [.-n- tyiueuj
jMgip'tziv’-f- — />-/. - /. Ptlu.c.l<^ J L<,vl,Lth^ 2 ,
/<••-', kJ-*'-'- iziM-c*. tj l&siix&iun foo ' IstUA- LtU- )VQ
&J- b-izH'LL pyl^i t-tir /\^Af vtCL. ')>vi-'- /?.&-£<.<sy fO fj ViUvi-t2~-
kwJ l" fartO Wit£ — 8. p T i
vj MvtClls&T, yyj% (}yl l^l t b— u{~ ^ 'C pLl,,J^ tyhnj t/bj
• pJi-^-C) /-<-■'. i ‘»- cj j3-[ __ ^
| jN'i-u.fi-o vw (uMAu^j (^jlJ, cu d at [tp&pj J
■ttioUs - WO iRfliirv * ' J ./hvti}ik
1
W'-T.- {> jluJlbVi^Q 1 Q7y>K'f'ttlj —
//y x
? ;-- T .‘*J
t <ctry jit'xJsty^ f(T lUty^O-iud
dirt lhu h^\ol JjJL U^l lu^ii'lvr - "ffcu l-^L$d ~ , u (jr ^
‘y fpunvjiJL Afit*4ivw SajuAm^. par.'c i^cfj _ - ,'-.
fu-aivu-^ j* p-itv^ - — ;2 av} jrn ■ > ■ -■' /.(;.
^ ^ IvM' **»"t & L&U44 ijwjL,
fto^l - vk ( mAt*!.._u<.-u , fV: c(.c|ot«.' ' .-^cfev yv •
— 'v({<- ..... '.
I ' L ffw ^ (AvvoaxJ^.u ati vl? C ;oJ.
r - u "f.- . -'t w ;>■..
y-tp^'4j Jl {H ^< 5x«,f i . -
-'i' Xn>t«A ~ ?■ , U-tzA4*r*.C fa-L/*.£■!,
frbitCUoo-c. 0 ^fjA-4' ’* ,w:~l)
tt\.
H
P
^ A V" w !v . u£ ( A. ? 1 w *, ; f f ^ 1
' t in t)
i6 n*~
C In c Uf
( 19 )
Division.—.. Almost every writer has given his own classification. I adopt
hat of Air. Lawrence. He makes four varieties1. Erythema. 2. Simple
Erysipelas. 3. (Edematous Erysipelas. 4. Phlegmonous Erysipelas
1 he “erysipelas ambulans vel erraticum” of'La Motte, and the “universal
erysipelas’’ of Hoffman and others, being mere modifications of one form or the
other of the varieties made by Lawrence, should not be considered as peculiar
lorms o tie complaint. The division into idiopathic and symptomatic may be
i da mea,
Symptoms. —Vary in the different forms.
Seat of the disease— Commencing on the surface of the skin, it gradually
becomes more profound until it involves in some cases the subjacent cellular
and other tissues.
Question of its contagiousness —Still a disputed point. For my own part I
believe that it is not. It may be epidemic.
Cateses -Predisposing—constitutional and local.
Prognosis -Depends on location and extent—the health and condition of
the patient.
Diagnosis,— May be confounded with common nhlegmon.
Treatment. Varies somewhat with the kind ofTrysipelas. May be divided
into—1. Constitutional. 2. Local.
Being essentially inflammatory, antiphlogistic remedies are required in the
first stage Emetics are often useful. In phlegmonous and cedematous ery-
sipe as, w en sloughing occurs, it often becomes necessary to support the con¬
stitution.
The local remedies are very numerous. 1st, cold; 2d, leeching; 3d, scarifi-
cations; 4th, incisions; 5th, blisters; 6th, argent, nit. as applied by Davidson
or alter the method of Higginbottom; 7th, tinct. of iodine; 8th, British oil !
.th ungt. hyd. mit.; 10th, dry powders; 11th, compression, as recommended
by V elpeau and Bretonneau. Examination of the value of these different agents.
ANTHRAX, OR CARBUNCLE.
Definition -A deep-seated, circumscribed inflammation of the skin and
cellular tissue, characterized by its hardness, peculiar burning pain, and termi-
nation in gangrene.
Varieties. —Benign and malignant.
Causes —Constitutional and local.
Symptoms -Vary with stage.
Diagnosis —Pustule maligne may be mistaken for it; also, common furuncle
and erysipelas.
Prognosis -Depends on location and general health of patient.
Termination .
Treatment.— Varies with stage.
FURUNCULUS OR BOIL.
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
'Termination.
Treatment.
#
%
( 20 )
PERNIO, OR CHILBLAIN.
Definition .—Specific inflammation. The result of cold. .
Causes.
Symptoms. ^ s \ ^
Diagnosis.
Prognosis.
Treatment. —Divided into that proper in the early stages, and that required
after vesication and ulceration have taken place.
FROST-BITE.
Definition —A form of inflammation the result of the application of intense
cold to any part of the body.
Symptoms .—Constitutional and local.
Diagnbsis.
Prognosis.
Treatment. —Varies with degree, location and stage.
BURNS.
Definition. *' ^
Causes.
Classification. —Hildanus, Boyer, Thompson, and others, make three kinds :
1. Superficial , involving merely the outer surface of the skin, and terminat¬
ing always in resolution.
2. Vesicular , or ulcerated , in which the cuticle is raised into blisters.
3. Sloughing , in which the cutis is destroyed either immediately or subse¬
quently, and forms either a *« soft slough or hard eschar.”
This classification being simple is the one most generally adopted, but that of
Dupuytren is much more scientific; being based as it is upon the nature of the
textures and organs involved. In this, six varieties or degrees are made.
1. Erethema, or superficial phlogosis of the skin without vesicles.
2. Inflammation of the skin, with detachment of the cuticle and formation of
vesicles.
3. Destruction of the corpus papillare, and rete mucosum.
4. Complete disorganization of the cutis down to the cellular tissue.
5. Conversion of all the superficial textures and muscles into eschars.
6. Carbonization of the whole thickness of the burnt part.
Symptoms. —Vary with the degree of violence with which the causes pro¬
ducing them have operated. Divided into—1. Constitutional. 2. Local.
Diagnosis -May be confounded with erysipelas.
Prognosis. —Deduced from extent, depth, and situation ; age and constitu¬
tion of the patient; and the character of the cause.
Periods of Danger. —According to Dupuytren there are four :
1. The stage of irritation, or the period of the first shock on the system-
2. The stage of inflammation.
3. The staged suppuration.
4. The stage of exhaustion or hectic.
Post mortem.
Treatment -Varies with the degree, &c.
In the^m and second degree, we must endeavor, by both constitutional and
local measures, to prevent inflammation or limit its extension, and relieve pain.
( 21 )
Should there be no chill, the best topical applications,at first, are cooling refri¬
gerant lotions ; should fever supervene, low diet, venesection, topical bleedings,
and cooling medicines, must be administered ; and to allay pain, it is proper to
give anodynes.
When the patient is cool or prostrated, wait for reaction or promote it, and
in the mean time cover the burnt part with raw cotton.
When reaction takes place, then resort to the antiphlogistic system.
When vesicles form, and suppuration takes place, apply, instead of the cold,
the linimeutum aquae calcis, or a mild poultice.
The vesicles should always be punctured with a needle, and the Huld thus
evacuated*
The cuticle must not be removed.
In the third and fourth degrees, the same general rules are to be observed.
Where the pus collects under the slough, free incisions are to be made, and
poultices applied until the slough is detached, or until healthy granulations form.
In the fifth and sixth degrees, the patient is generally prostrated, and we
have to resort at once to stimulants. Some advise local stimulants, or ‘‘the
ealefacient treatment but as the parts are nearly if not entirely destroyed, and
must be detached by sloughing, it is best to apply warm poultices at once.
During the detachment of the slough, the patient’s strength must be supported.
ine ulcers resulting from the detachment of the slough are generally indolent,
and must be treated on general principles.
Where a limb is entirely destroyed, amputation must he resorted to as soon
as reaction takes place.
Local treatment during cicatrization to prevent deformity.
Local treatment of the deformities arising from the unfavourable cicatrization
of htiHis.
SCORBUTIC INFLAMMATION, OR SCURVY*
Definition,
Causes*
Symptoms.
Pathology,
Progjiosis.
Diagnosis.
Treatment.
SCROFULOUS INFLAMMATION, OR SCROFULA*
Definition.
Synonymes.
Tissues most liable to be attached.
Age at which the disease usually manifests itself.
Causes — 1 . Hereditary. 2. Accidental.
Characteristics of the “ scrof ulous diathesisP
Symptoms —4. Constitutional. 2. Local. Both are modified by the organ
or organs attacked.
Diagnosis.
Prognosis,
Pathology _
Treatment -1, Local* 2. Constitutional
{ 22 )
d
ir
i
9i/U> W OUNDS. /&&& 3$>
Definition*—A recent solution of continuity in the soft parts suddenly
occasioned by external causes* and attended at first by more or less hemorrhage.
—(Cooper.)
Objections to this usually accepted definition _A wound may be pro¬
duced by violent action of the muscles alone ; and by the protrusion of a frag¬
ment of bone. We may a so have a wound occurring in bone,
CLASSIFICATION OF WOUNDS.
First division —Is based upon the nature of the instrument inflicting the
wound. Thus we have incised, punctured, lacerated , contused and gun-shot
wounds.
Second division —Is based upon the introduction of some venomous* morbid,
or putrid matter, into the wounded part. Hence we have poisoned, specific,
and dissecting wounds.
Third division —Is based on the regions or parts involved. Thus we have
wounds of the head , face, chest, abdomen, &c.
Fourth division,— Wounds are also divided into the simple and complicated.
Daggers of wounds,—T hese depend on—1st, the size, or the extent of
injury; 2d, the weakness or strength of the parts involved; 3d, the importance
of the organ; 4 th, the size of the bloodvessels involved; 5th, the kind of vessel
'(artery or vein); 6th, the diathesis of patient; 7th, the age of patient.
Causes of death— 1st, hemorrhage; 2d* tetanus; 3d, traumatic fever;
4th, erysipelas; 5th, hectic fever; 6th, gangrene; 7th, metastatic abscess.
Process of healing.—— Until recently, only two methods described : union
by the first intention , and union by granulation, or the second intention. Pro¬
fessor M’Cartney has established the existence of two others, and we may,
therefore, make four different processes of up ion, viz.: Jdfo
X. Immediate um 0n ^ „ A
Media ^ UnKm by lymph or blood, or union by the first intention* {ix aXl
3. Union by the modelling process.
4. Mediate by granulation, or by the second intention of Hunter*
Objections to McCartney’s views.
Mode of organization of tile lymph and blood.
Difference between Hunter and McCartney relative to the necessary
PRESENCE. OF INFLAMMATION IN THE HEALING OF ALL WOUNDS*
Comparative advantages of the different modes of union.
First and second should generally be attempted ; because when either takes
place, we save /imtf and pain, and obtain a strong and generally but slightly
deformed cicatrix.
State the objections urged by many of the French authors and others against
these two modes of union in large wounds.
^ AufcU'*L$ CtLusZtvf <Z4 Z, foeAtud
jifadz^ <jf eAw**eA^ t £r £i-ifs&tt.fSZc,
Jpoi^XtuK - s &-YA-j*4t tw*v»A U-&d- fax-eL-H
■Jidp ItZ&^t; (,*\4fofwot*£t t*w//4»*vp ^ Ifr^Y/n+ub -
tfxprb**? ^ ^y^k? *
l( 4 r A4yt y At rie^^r'tKt
<yf ^Jj6 - Usrj fahn£> *~ /uAA ~ ^<- f‘ l U *T^H
y***/ fvr:o*~ ~ A w+
z<
2 toAkUf*
A-/*-v **
I / £ /
V. v v C>
y* ^ ~ r<^> v'
-i /ru. ^ -
r\ / #
Aj. 1 4 uy v-t
^ / ?y~?k>
/ i ;'>>-••
- or^ c^A C. • t f/
‘ "''A ,- r ,_^>3 Jt-
(o ~ Ajrtr^c
4-^t v>/ v ^ (a i *
/ i i i
4w {h\ flAj &*&■+■> L
/ / ,
j/'Sfxur*' Wvt-
g/wstfAJ/iA* i v t ■ ■ ('t i n
JDzr *U(b£ h xiuj}
j / ip I ; L h~ - { ' HB-
fCo (; />■;
4/
^vv.
7 ./- rr
T/Z*
tik*-
4
!Ww.
. /J> V> vC ^
1 A ^ *f“
J
/,_. e-. ^ :X>#v /
ly 'ffitd
f iyf
/ m
r
A : 4 - - >v-C . : tc <y/^ y
t 3 - XU & £'**-
C/ArJ>. a Ay d <W *■ • ^
^ .:*<*■■ & c t- ■
f"^ ^e^*' *£^l u&tt^
£l££&v-Cj J #r'L*.t*. A uH\** 4. txfi) Jit**' <*•- «*»v '~£*. J
^c,',Al fie^c ,u/t,/ tfO lA ?zf I4exe 4^.j
Jy^i j Ajjj Ay fu* ifc+ia&h* P L £x y At 'y fjciA*-'U
^ ^r-.t .,. y .x /t-*., . i.. / (X-t^'f'
(ZtZUJC&'f J i^V^A- chfLr- i
ctv^u ATi^lc \£,
/> l-tU'-flU- OltM-dt- — •(. v
-.7.- i
. a.
. L tv * 4
it v La IcR n ; 1 l v t i i { /tMX
rn
H
JjU
^ $t£*wV v/fi-fwv^ -tfX* ‘/Iwrwvl^^ irjrv^v?) CL< t <
VV jkC^fcvv vv< ^vfiA*>&Lv fc (viAAvlV ;< r;..
, /C-^4 X /#t /^ /jjL'C^r^ Cpf /'r „. _
[• :f*r£ > *'*~ *' - £&&**&<' kV /Ut /
// A*u.£- /y /&£, ft , k/ i/ ^«. ,, ./if*
/ t /«C /wr«« J^t* -** 4& /L / £s£,i t , ». v .. .
<&/>*• Z^v<f Tit « ■/ *75Cv &/ /f* * ■*-
sit, A+ve^-y ffl ^ J*- > CH &01 L»
; : ».* VV ^ ? - /, ,■ Y t v^ .- -‘ ■
i ’~$i**-e- /V~*£L*
Ss* ^r/Kt^^Y /C / *^y #v*^
2 _ /"
‘SZ-i'O /^w fie*-
U 1 i w»- /i'Ai iui 1 4^ Kw 4 i / 1 ififlU-tt
/■4( L + u/rt /trH
*<? n^t *w^jUvuJ
£^£
/ - Ctt^t) ^//jf./^L Lt
U v /Yaii-v i.vrt A?V —■ y/ l 4 A , i j- ^/+*. __
[7iu-1 * ~ y {Xi/j-o /«-<o ^ Cvi^zst
Clmst _ »f i. L ,^) vA /„. j.
Av>>_ > c ddt-K.^
i\- ■ ■• j - V
Y ^ > ty \uwt ; ^ ^Vv
! §/ ^ Lvwn'- G**,!
^tyM^ £t+S) (TK^i tHu
_! 1 K. j 1 f ^ ^ "f? U V tv fe L it
^K^<.*, /-tn^Y^ ku (f-liUC I,
Aj
"7
£L i» J , J'iu- 1- .?
HVK
(h ik
' O A-t, ]—
t Hu. ; (' -<•' /^,4t4^_cl
£wtt~ yL/iC -
I| W't-v)' ^ : r - *y 7 / l ivvii t'-lCtt ~C •
-Hr
lw-^ « ^KC/ ^ ^ju^v«ct Um. 6C_
Hwvl-W | ^ l-vt /ivt^U- l^Vwlk ( t> .. ' :■ vvv
■ ! ^u-rv^V^i UUjt^KuJ lu
Lj. lilrvW ^ ( lw- iv^y^t-- / W ’ r •:'s ■ ~ jV'pY
Uv, lur^J^ts fyfa^++£tL- ~ 1/
■?A
rri y ' f ' |
I s'Ct- C ^>L ^ __ //, (hw-t)
fc&A <*L/ ~ ftKA “<9V^ <WL tT^&Ztn I
4 /-. Aw/ .7 / *AA
j /;^; A i L .(O^V j J -! ' A /^v *'04-'^~'bx--**-C
I /^t-< 4 . 1 . WKu, 4 '^ ;c_ --" tUL ,'*n- t^-ip £<^'fAo C-y
J? /.,. / cJj At+r&Z. — A <^x^ Ll U-L All /iv
^ #* * *
Q - &? &-tyL tfe-i/lj!' d’Yr^. Jii^ < / £yi t 'Qc*t^
\/ht^l l Jtet ^ c At- /- aA^ A ' '
71 ^ A wTfc — /^%A <niU
J 7 ^ - aA iA^M^ ij pthe* Av h <\
/■tdj /- c^_ fyl /{. ^ <_ AA
. / / ' \
, vw *— y
7
j / "* v y - — w w -
I ^ - 7 > ^ 11 Jv i iv '— J ^ > P$L*~ **- C/1 L X u4 Aj
&U„->r£{ X/tU4. i^' ^tWIUL — A
A T-^fco*-*''- /^b-t-t-^-vL./ '*&£>/c£d /A-t-w-t? A A- J/ Wm.J
, / : / ' / "* / y?
j |' £tfi( H-i-'f} r ,L *-' <^V /-*■ < /vt <? I L Ct L 1 -' F &--Ci*s*~yQ
,. 5^// ; . c.. Lfn-tty^ dx t- C\ dr t Fu*J)\.e 2 s (L&-C*u^
j Ac-CtU'- pddr 7 £f <- £u-d T^ tl^. 2-
faJCd- — A ~h\+xM — A Jhrc ^
£t: 1^ S'F » ^(A ^ ^ .A'^- t ^- Xt—L^C —
/
t- :
\ v >*.. \ v*. > ^ y
■
■ i
,, Vk S \ \ V 4^^'v ^ liWs 4 A
1
3
% \ ^ > V # * ^ V' 4
% V ^ ~ v
I \> V ^4 V^ >*>.\.^ ^
\ ** » ’* ^*\ ^ >-n^4 ^
\
Y ' \ •*■ •-
S > ,\ *» > v.--
■
V %
Y
V~ .rV-N
is s v*
% it »*,
■ '
V
*<•** ^4, . 4
■
>>^\ *V>» **Wv> t V-
, '^^N, ^ ^4 5|^S
% \ JlA
5w^ N N*s» \ ^
vw** VY
' '
v. «•» v\ *t\ N .>,* V
JKKasrss
*3U*^ rfzm^czt,
fa €UM dy ( d* /«i^ ‘*‘4. A*** tv+^L'
^ K< ^ s ': ^ il^^y^,
^/. £fc OryCu**~(jts Qv^Jam. &tun*> o u~cC- ti^tuaXtO^dtjH^.
ud^iA**^ t& ii^ fj tst/ct- i*- a^T) 4 /^ 4y^
( 23 )
—Divided Into—11 constitutional; 2, local.
CtRCTHtSTA&CES PREVENTING UNION BY TILE IMMEDIATE
OR MEDIATE PROCESSES,
1. Bad habit of body.
2. Diseases of various kinds.
3. Simple fever.
■1. \ itiated atmosphere in hospitals, &c.
3- Epidemic influences.
Second or heal,
1. Atmospheric air.
2. Foreign bodies lodged In the wound.
3. Large coagula of blood,
i Laceration or severe contusion of the parts.
5. Faulty dressings.
Character or the tissue by wnren wounds are united.— Already alluded^
to, ft is a singular fact,, that with the exception of bone, all tissues unite by a
substance different from themselves. %
I he different classes of wounds may be next considered ; and first of
*
V
INCISED WOUNDS.
Btfiu, ition .
Extent and direction ,—Always to be regarded.
Characteristics. —Pain, gaping, hemorrhage.
%
The pain is owing to lesion of the nerves ; the gaping to the ordinary elasjj^
city and contractility of the parts, and also to the situation of the wound. Tlfe
hemorrhage proceeds from a wound of an artery, or vein, or both, and its cha¬
racter is modified accordingly. State these modifications. Its activity is
dependent upon the character of the wound, and the size of the vessel.
Prognosis,
Treat merit . —^General in d ica tion s.
1. Arrest the hemorrhage.
3. Remove foreign bodies.
3 . Approximate and retain the sides of the wound in contact.
4. Prevent or subdue Inflammation.
5. Protect the wound from injury by appropriate dressings.
First indication -Hemorrhage may be arrested either by an effort of nature.
or by the assistance of the surgeon. Explain the process by which the bleeding
is spontaneously arrested. We are not to wait for this, however, but must
resort to toe various agents afforded by our science. These are numerous, and
are to be modified or varied according to circumstances.
1. When the vessel is deep and beyond our reach,^as in wounds of chest,
abdomen, &c.~—-our best remedies are bleeding, digitalis, cold, rest, low diet,
and positive quietude of mind.
>. -
( 24 )
3 When the vessel is accessible* we may resort to
a The ligature.
b Torsion,
e. Machine.
d. Refoulement* or reduplication.
Compression.
/■ Refrigerants.
g- Styptics.
h. Suture.
i Plugging.
j. Seton.
1. Acupuncture.
1. Electro-puncture.
The most important of these agents Is the
LIGATURE.
History .—Mentioned by Celsus; but not generally employed until the time
of Pare,
<£ Effect on an artery.
Effect on a vein.
# Changes which tale place in the blood contained in the vessel.
Ip Changes which take place in the vessel itself,
§ Manner in which the ligature is discharged.
W Cause of danger when the ligature comes away.
Time required fa fl he obliteration of the vessel. %
W Materials of which ligatures are usually made,
m Shape and size of ligature.
Mode of tying the ligature.
^ Method of apply ing a ligature.—Tbe pends on the locat ion of the vessel.
1 When the vessel opens on a surface, as in the wounds of amputation, &c ,
we require a tenaculum^ or artery forceps.
2. When the vessel is deep-seated, or when we wish to cast a Jigaturein the
course of a vessel, as in aneurism, we may use the various aneurismal needles/
or a bent probe. Objections to the needles. In all large wounds it is well to
apply a ligature to both ends of the vessel. Why?
S a be ut an eo u $ ligature.
:Ligature d > attente i or ligiture of reserve.
Scarpa's ligat ure,
Ligature and section of the vessel.
Temporary ligatures.
TORSroX*
Definition.
History ,
Arteries to which it is considered applicable.
Mode of performance.
Objections' to its employment.
V
* ,
^ Afc' |
‘ &h&BU& jf%&/ ..
/O*^ Jk£~****+**' ** 4Z^^> (^Wd
frj&& &&
&5^ <?^t.
*D Jky**
w&i) ^ ^ ^
A**-* '># 0~£~s^*£ /u^t^ &u^f^ r /&r^ <—
sh^S^AJt~. y /C^
^ £#Z,ts ^ <<* ^ ^ ^ I
y / '^ -j-.«_< *.„,, x.,^^c:, >k./s.
: >^ A- U*£> d/>Z^
y M-m*v~+*mrr <v^- ■
,^_w <s3j^ £'S>iy*/Zy,,J:\ X
<?-A _ wf ^ ^-** " tjr * ^
y /u^ r ■jj^-tdfc/- 1*:^^, i&L**&Zr.
z‘&+&-4f~
^ <**^ ^r*/^
*/*>>**, ^ d &Ji
&4 4^Ut^4^/ ^ JLs d '
d&*t /&*# 4-*mk+^*€s 4^
y7 # ^
^ J y ^ v ^ , effadh &&**-&£-
ugMgEMjtM- JM X jr rrtiir «y ry Txrrn —n—,_y ^
£Z£a <-**~3 *~ A~~ ^ »/' ^
0 ^ 4*^0 ^ " ■771.*'* *- j
V
C A
)e
-4< '
J*t»*£"* t*' a,-- ■
(rfh' ,g::^£ ^ ^sy
yj£l>&~fr\J<~;J- &/ /$£ -,- / £ ■ — / J \ l*J& l.t, '£s
*jfip l-* lx. 4# 1 yy tsu^f-/ a jgi <8>*v»€**4) £*>--■
-u. .'
-Si* 4 ^ /#»rv^. t 4<3 ?--■/■
/<h*&~e£. c$t-Y.--*i &r ^
dpi €dl ^ ^* v / *y *£■**%* •/ y^K-
^**»- ^t£*- *!/»•>• ■f^V' i."’ / ^ d/H>. * \ A&C-- .#***••
5/ 3^«- /2^j*.v .-^ ^
^**j^v* % ^ w ^W«2 Ad+* Q«Cs' 7%£.
/&c&f£*y~& ^ _ ££<% it ^ de-t^d (1h t +**&' ^
i 4 *• / ^ *jtsty^ dyjfL+r Of £y -i .-, -, ^
& *~" y' 1 ’ J£ <£-■• ^ (^4-A^f l4vtf, t ^ ft fit f Cf
, i o Ca****>C C #-'&€■ i>L-*£ ^ f\
B Ajd uytZj A'i/ #Y -> ' :V* j —
* # v*
w /ar ^k* / . i;- :! cJ /.-X — $ A , *■ *■ «. /y..
^ P?v>x< <e*, ^<ft ^ •■ ^/
A*** <X-£c jr 23T fa*/**-/*- ^'y'v-f ^l
***• ^^C-C *„ "
l «U iti.//> (X/YTifi-t,
ah jcUCl "
f
Mguc^xL &csti^‘ u. a*-*<ju, £
‘ iyyfc&yA <*cut>&^ -r
S/ /4?'/> %s> ** * fay
A f rn-iCt) ^e.yf- ~rfi L
l<- '~fi-cr //f /i££<£^=. /£'
yt^ >4t- <? A y^St-y
' ‘ " C/h^j -CA-
/ - Qh^b$~
Is~y^
-f] Jl/r^A'
lAS/t*
“ ^ ’-p**
,^vJ h Sh++~*~ /& /^te^>
^ £y* L #,1* '/" £/ ' ^-U.
/7 ^6- /?•<- ^'t-c — '. ^ ,v
Jfc:.yc ?: ^/ d for»+*yC 'i/
: C ' l pu f ~ yl /•^^ - £■**-'-* t*c, s»
4*4 tjyLy? f&£*- ^ ^A/^; s? 1 : p>
<»//Cv &<r-n w«t 1$ iUs & fau-e'-'.-eS
6 f '] ^
(y t&24 £ c ;^ uO t, L ^
' '^■-■%$K k^UA't t^wro t/J Iti £H AQ
{p\\, ^vvWMii- ' b*-$vyi~ UnA^
/h^yir y,^. jitJ'ifr- i
^Uztu Baa bjAil wl , f
Ct- K£^>>-v ^--£ ^ Q-Ct, I iVv-^ il fay t Y\lc,t/ /
tyrttu ,U fCt // tfaMvz-^CC tsmL/lZ<,^ y ,
ta/ H 4
I/q OHtjp vv y J/i
'U*
A^ VW Iq
' V W^' y/'Y^Vj
U/n.
r"UVU^
Ik' - - ■>
^frvy ^ i ,/- - i^ r
" Ls ''
i^'6-;ua ,l.- f< 4- (Uojip astZ*^ —
•v /T-w <
v 7 4-. .<-• v /V<v/
j^ -e~ l * < J
V £ : f
fa
^ K^ j
^ > /;> V / |
/<. /i /fc^J
/Hu.
JL^ .• ■■- : * •'-'
/UsJjskiju* Ol
f^Tt^a -
ih.
-it
rm slJ 'Lc-
I&y* - 0 -*
.•V) xi&iA - ••'• : f vJ
4
£ *=»
>// r"N,
;' /) Q^^cAA^l^ 'i- fauil.*j£nJ
•*' f £ L u ■:';;. : .r.''. 1
t:' j 'r ,^ J £’.. C-<* f *■ f ** V
9 » f * ft ' jO jl:. /
-r^x ^ r - £7 vw ’
^k*o fyw-nejn&h w $ j l-wb Yfyt*- j
4
u'i* ^ ^ / ^'V /■!*
AvvU^twV -6 U^lu &i~
tJy^C^C ^ k^K fy l' A^C* fr t rf* i & Ms t/ls^v tyi-i^v
m^v- a^l&u *ej (*. +KZ:
.ft <n\j
>5*
.7^'j otn^yT-r** } ' ya-u .
l^^'i-’Vvv *4 Gi\ju~iL ■ JLi.4J^JAj.‘ v
Qh L'Cl Uf GVc^y-h-i t . ,
/^f v4fci >' ; u - W!r L M y _. _
^1/vQ ^)uLii - <MjAjl. ax x \)
ixjfJuyi dMrj) tP^lrrM WAH io-cfl
\)i0o l//'^\y^j h y jAi Vt | ‘ /,{, >
/'^ir^vvx-c^ ^Jj ill j^*^srvu'vvt^" ^n.,-i
liiv^|.}K *jj ~ H x ^ -6^ Uuk WUd U| |^Ws> ^
( 25 )
MAC HU RE*
Definition,
History.
Arteries to which it is considered applicable*
Mode of performance.
Objections .
REFOULEMENT, OR INVERSION*
Definition,
History*
Arteries to which it is considered applicable.
Mode of performance *
Objections*
*
COMPRESSION*
Importance —Useful either as a temporary or permanent agent*
Points upon which it may be applied .—Either directly upon the bleeding
surface, or at some distance from it*
Class of wounds in which it is most useful .—Wounds of extremities, or over
bones or firm tissues. t
Agents of compression, —1st, compresses; £d, rollers; 3d, hand of assistant;
4th, tourniquet; 5th, garot; 6th, tissue itself,
REFRIGERANTS*
Cases to which they are applicable.
Age?its usually employed. —Cold air, cold water, ice. Sec*
STYPTICS AND ABSORBENTS*
Cases to which they are applicable.
Agents usually employed _Salts of the metals, creosote, sponge, agaric,
lint, cobweb, dry powders, &e*
CAUTERY AND CAUSTICS*
Cases to which they are applicable.
Heat at which the cautery should be applied*
Agents employed, —Metallic bodies of different shapes, mineral acids, argent,
nit,, &c*
SUTURE,
Mode of application .
Cases to which it is applicable,
PLUGGING.
Cases to which it is applicable.
Manner of applying it, — Speak of Sarra’s proposition to “ plug the artery”
in ordinary hemorrhage.
SETON.
Mode of application } &c>
Mode of application i &c.
( 26 )
ACUPUNCTURE.
ELECTRO-PUNCTU RE.
Mode of application t &c.
/ Manner in which the circulation is carried on in a limb, after the obliteration
of a large artery.
f/ SeGQn/ l indication .—Having arrested the hemorrhage, the next indication is
to remove foreign bodies.
Character of these, generally speaking. Should coagulated blood be consi-
dered a foreign body ?
Manner of removing these bodies.
Third indication -The next indication is to bring the sides of the wound in
contact and retain them i?i this position.
Agents employed to fulfil this indication. 1. Position. 2. Sutures of different
kinds. 3. Adhesive straps. 4. The rollers. 5. Splints.
Fourth indication, Protecting the wound from injury is the next indication.
Agents employed to fulfil this indication. Much more simple at present than
formerly. The lighter the dressing the better, when we wish union by the
first intention. Cold water dressing. When union by the second intention
of Hunter is desired, the best top dressing is the “warm water dressing,” or
poultice.
Fifth indication.- To fulfil this indication, antiphlogistic;*, both general and
local, are usually required.
LACERATED WOUNDS.
ft Definition. <■**"*' ^ ^
f Causes.
& Characteristics. &&****» *4w&, / " ' * ' fit'
d Prognosis, Jfikd ? /lVt/
Treatment —General indications.
!- Arrest the hemorrhage when it exists.
f 2 ‘ Attempt, if possible, union by the *< immediate or mediate” processes.
Mode of dressing to accomplish this. Irrigation and water dressings.
3. When suppuration takes place, promote the secretion by a poultice, or
,^w r arm water dressing.
4. Keep down inflammation at first, but when suppuration is profuse, support
-T the constitution.
5. When the extremities are involved, the question of amputation may occur.
CONTUSED WOUNDS,
ft Definition.
Causes .
■: Characteristics,
? Prognosis.
Terminations,
f Treatment - General indications.
, 1 * When contusion js complicated with a wound of the integuments, close
the latter as soon as the hemorrhage (where it exists) is arrested, and foreign
bodies removed.
J?7T*~, t tf' vi
^cJ
I ^2^4^ fflfatt 'jlf )r'\^ /fa^*<? ^3fw^ £tA}-£ js$ /£-*? A' j
1^*? -.
hn
fa
%/hauM } fafatfzi MU&U-i o*h)
dt&lHMl ; /<^ (MMiX/Jj J)dsh 7fan>ujf k W-fe^
lM~(JfL.kt&WPW s4- MM L At' $Hlfa jj&A-^ffiU
^UJc fa JtoJtlfa tl)U&L, *fajht&U
( / L me/Ja :ii^ ft
~(&td> HWfai&i*, Me Ufkui *toi 7uU, t .
: ‘p4^4) {■.:•"> <3 tfU'P-i'L&t;J*U/ U46&
UjJM- / kJri:J hi ’ : a tt# //.‘^s/- J'X-l
tr
U&n-'hst’‘tfi&.t/ fau q fof Jft-Urt-
Pf-UM^tT 'far- t /tt* /
faif ifoy tii tt :,!’*'/£ Ck - d&d&tiy _ /}upet&j*
I fai p A\t’-d Ufaim ~ km* tai W- h* (?di£ I $'’-
I % r t^ , L
ifahfcL pi ?:jwk ti'kfx 1}'ju~iUJ M fa ; ; '■'■ >‘f4
lf~ : hlW'A '^ufifrC - 1Ur :il pk Citr U &•. r - /; •;•/ f ;y7*
hf tuHlttelMs ^tA&ju, IkUb Ww<^ M
UMvl fajfab- MzM&z- ptfontii tffarftftfaj,,-.
M ; ’ r f-ufarfa. '■■ "- $Mt f'htrJih
mm.! Crtiti<-*-<' U : vfaLeU Hiy. xxfair At A'^rS
c£uJ J tf'C- fa **h tt!:*«'■!'* ■X’-fa^C^J.At'-^ :>
fauhi ') wtii fap M Ufy A,fe/ vW 4#$famfa ttriU 4.<.
ifttf&A cfas l&tZVU tuyt *CMJ Itffit tu _
<sfain-i+ijc- tju. ^SMitXud tntH )4t>ufao Itid 4
fifa t-c itz**jkk jki fi&cC " _^
■'-■ f&u OwtAhMl ^Aufalfa^
ihw\) jiih l fa/r ]4 ^mvC^>U|
V ' J
. * ?v u ■ , / iyttfidrfil
/ ^ ^ dj 2 /&fo%. Sijfatha* M# $
J^Sr^Of4t mcmudo faw^j Sp&l&a, t&fa&tu ^
^ /foi-ki't m&l ifcf'/fiAMfafa. j iw
Oft-fakf?.-,J*J&. iirt
■/^t £rSO\AC(^e! jLtltu£^XiiLf£^j>. &S$ fltr& ifflffab'i*'' f -df » A*tAJt».jA 1 " ^i
^4h£J. J^.&g^ii,vicsn:<Uj ; £■/.
(liflv
f$j« -farr
f
t/fiSti ■ '' hy /^ /- -<-2 y /'/■ ,-; ,'■> , >c f
' ' ' ' " ' ' I
/fipj/fa fibhi&iA^ ciy-'i- J
iuxti^t/fadfyu . L . d
. . r/S * 7 ^77^ / f ,rt 7 , ^ am
■ ■• ■ ■ ' ■ ■ //■'■• . v / ■ .
Kjj£. • p«CE^k - l&n4m, Si, Qe$ M&diL
d-UU Sl'M'&tX'/i t?t, /'i- fib/ fyt&irgd.
I mSifi,Jtfiiki,h fa, A ^»;«w
x<w2. AtSfaJfa: v r .
<\*-I? 4?J. <lj/ <-•»- ..-'t-'V .
t_( 0 / / fi
ki
ti '/■Aii fi<££far£fc£t’-.. ;••/. / v
Wp^ j - IrV* i
&LbdSti * — ' ±lf r -lL* *
mr w m zr n« ^ f r *■■ v r ^ ^
''44tfcpitMCm-i
<;U
* -< K
#W W Jt ?S4 {&*&-* et >ib
Jt t'J /?i-• '0i-'~/r
m / | / * t ^ I-
hr — • ife fli/u
£#£*'; Mfi&M'i*- ■ - ; - •
>U<‘>..^,f J/M'iwd — i ij{\j^ ,m v i j
I ’• ttic J^p. i i
1 Imbfeu ^U^vDlUii^W^ L • ■ * ~ '■ * 1
to
^ 4 ' ? 1 f i|V ‘- ^
1 1 4
1 1 itf&JifaML- 4(t1>4&/' Ixdkf 4 %/sM^ -
h | /U/tA\. fa^Cb<i Aifaxfo',yp fyr.J^/;ifop/i*~S
M &/ N*/-»' '.-.• '• -JU- &-■& d\'Lfc/H~‘
g jk#idd<(U t ^^'i‘^ Atjfk. ^ - v ,„ — . _
Lb,^&0 £t***ueL
4 j Uil^tL d^tnctu*^ 9bof&M
I
||| i) Si 1 ■' ' -' -‘ ' / :i r i , ' J, , .tJ
jff'&V * ^l-Trs'-C *- if '/ f P’T' ir L^t X/~ x -<
y/jjf a / 5 j* i ^
'^/tySy A •**•/.* ,’ t . "&,~/zs CrC^*qjz?^ ^4
1 4i^-t- ‘C+, ^Sf £ C jS' tf 'pV ± £ f / t 1 JLQ ^ J JU^ndA
/■ v/ / rt c'S /i~ , A^tb /u /■//((,, v ' (•‘-^j
/C^t-A y ciJ ./ : c //rn v SjSur/t/~ \
j j * 1 *\ < < */j /
:'‘^Vt >-/!•'• - /' /■ /-urf d /fLfrr /h~-0 It i^-i
t S ^<>Ji
$ fzT>:r i. pn+*ltj L* ^ mrr
I Jg^y-^f f'L- £<? &? tt\yjf^irp> fi f/l\
T^tS ft t * t & /f i'M^v- <V- <f j ^‘. hdea sj Jfsfr&i) ‘
[■ J». H £ti ^J/yW -^4 i'j itvv/j Af 2 »v-^J
^ C-c^^sf /UU TKu {vi-cufaU ^yhJi S /j~n Li ,
.'
f t '&' L •-t'ivLti - ._
: at ti£ J (-/ n t b f a\fct
$>• ^ . .0 t u i j j
. flytJiA'l. A ; -y <?«*rt£j civ U- b-t L
j/)- L{ ^ b~C<- i - *
?
K ■
% n -
. c irn m
' 1 ^
ftos. m ^Vi.^ \- - V\ i- • „ ., r ,,
H ' it- \ '/ i , I • I ■ ■ \
W *> • l flA-Asir •' ... * b IQjJ
!/- ^V>VV X"
_7 ■ ■ **. I
1 J T' X/k) --
Vt
,}(M/V
'I Y-illl 0 t
> .o
^ V-iL^i! fytMrsr ‘ \ , L 3 u £ K '<•’.'
p A r - J)a ft rU t
y (wtfUvWfU )h *4
6 lU,d r j) 0 -Hill £ S (h v<^ H t ^ ^
—*—— --* f Wt -Q . ^ . .. ir ■ f /
: - 'j/l/-£ ^h 4 * _&r rflL *tf -/’v;
fi— ^ ; ^ / r^&tpL&+\ cS ,
jjdifrL ■* ':vv^ ^ c-/ - J s /t 1 /; '
.‘.Ou/;i-/*{,*■ &t{yf
M.t fetish ^ ^ / tr+is'C-i^t w ck ^ 4 - '7
I fan** hCH} i ^/ir ^
- ■ . ’ 4 -' KTc it ^ ^ ■
Kf/ /-• , /,* n ~ ^
v //^s 4 S?t$ <f) A'^/j ^ j gf /JC*.
<£+ ^1^74^? C* 1^4 Uj /<u &/<<, JL-^
A (*k> «,.P fcz,» fau/n/U Uin.r^K
I* fey Ze.fr l /'v j<z-tC- J <£< ; 7 c< ^ ti’ft-i-L'r fa Ccj k., . r,v a
/* ' b ■ '-’■■ fi rK tfprvl C&’t« Ci ?** {<<■ Ctt-skS#* ,4 Vi V *7 7 ■'; -
_ v Ut’t'Jt/'-Ci - y\ „.bK h i v
f >:. .' /, / , ' . 1
^ ;; fotPhrfZt Cfl*£fL&uC ffa O* Sv t j /. /
/ ,, • ^ *• - > ‘ • / /
f: Zpi/Ttf^ti ccj - iW ^ tretr** &rtMk*\
tit.I A*-t.£«t 4-( ta***-* t/i tOc^T iy J
I Ii ■ ■'•■ ' " ; ^ /frt/k ksvUliCc , CLffw iv -/:?■
I I (l&li’tj-- li *'<- t-L i^U-v? tv'/lt+v 'jLitjyjj ~~ L'cir\^ -- A v~ti)
| pTPtCi 1 -Cty ' ® /^V.V^ it«v^ Cri^tvv^ 4 » i-«. A /. V 3 . Jj'J'.-A/SV
U\'Jc - <Wa--| a rri) Gt'vwiv- Ui^'Vv "■ x 11 -
Cl - ^ 0 Wt
i&'ii't L -
. ^ ^ ^ f _ w ^ ^ ,
v U^-iK. ^ftf t-.- V tastec
' ■ ■
/
/> ;r
A ii'Lc /c t it,Lt a
i J £v £l? /L^lt ^
’t-b&'r- £/Vv
C' L??t^/' l*bt{l j l ^ J> 7 t^ Px^f
Vi'^ P^njA-t w ./ <y£^ h^p It^XTl m iS £ytL
,, - '■■■;. Pt/’y — /,
1
1 /£■ J,/ A i- c%^/
2 ^fV7yv4^A^ — ^ A? _ * /^iLt iZ^£^ Ct// fi<.
C^^^ lt./T; I ty I J L Cj — J Ou f ^ j^y 4
&pH^j - tCH,-&- /h p^^OJ* *£ Otfl. y tK C&i.J JtH iy yf/pO
4 / K^J h* l &J&Qt Jn* <&C £,* p. ti^C
4 ^^/uy hp(o-<-^? — /!**-«' _ PV {XCt^
iiruij fcrp,,U jPuddtet^^ Av &./&± 4*0 fad
hv v (MrftWrihttf ,'p/Zl^ £(-l&
(p&C J £aH- pt A tfaltf gS 0^}y^ &L-C'£ £
fairHriJfrt i / *■• /c£f>g£f '£tv C A *. 4 4 ^//l .
- V' L /
7 >z&s "/ - /*£-- /> ^^ ^ rt**.
ft*y- // JlI £ ft jjfi ^ w ^ &{t />/
r>Jt r l h u (A^Ls± it? ' ';” -' -C* f c^jp - ^ 4 ,
■ ■ : ■■ J , ' , . l ;A ISI- L tt ^
pfit- / ft-Ut i: > t / l r.y ,'; < ,
r c ^ ^ ^ ^ 4/ ^_C'-LA'<£^ j '£:*** y -
/ft C&'ttfK- +*r frf '£*■'/ //» <TN.^ ^ *** *■*.*
■ -
; U^Vj v- ^ tt*M. ^ S^ III ^ I . rnjw« . » - ^ £U~si-‘ , (f )/
^ c CL**#**; s ' — J}/ J&mLC' ^^
/ / y A ^ ,
v . / ■ - l/^r/t
h i /** *_ 1 ^ jt^ci - /i* <?**<>* c j
' * s
(t\, i) Jj p-i ‘. i Cctl*} * &-fi*C.^ . < -•' v fc £&€(&
) tsii - r<£.-. k
/' ,Y ' />'*-
/ ^
jfri ^ /o L ^ V <■*'•
itA /k^ h^.
y />< t
^ tj / j
/
f,
./•df , A
/ j .
/
£
PlbKdtu Lci) - ^ A.t ,Al £<. Re
/%{• / tfCC-tp ,'f .L i(h, . > <>Wv-<7
4ft~ tb- ^ /{&-* , '-.-f ■ f>l S'
^ SSJTJ^ 1
^ & /C & iM'C*.
Jvft i . ^L At*' <? — ^ (kttt't Mvii^ U? t £t (Ihi *t $? £
£ „
#> v
d'H\££\,\r /t nn^v i <£a**/ A* £ La C+vt $ /1
P~h/lxsJ> \‘/n rj/*, ~$h& u C * Jr £ f K / 1 J-L^j
pir s'/ Jit* v*~4**/5 -' ^
j A r . t;. * t v- £/' — #1£ ^ sL^~C
/n, ' 25 ,rr,ut^ 4 5
/l?/ .'. A-ty^ /(■ ),L f >v • Jvt^Vvi. fi/tli'Yu ill ^jp •'—£’
fj %^i A,U jar ^'t<- /hu^O- u[ (Itsu^'i- yUJL i/£ i
fjz*irl fti U- tt-Th u f fit! C ^4Vw-K ffetr-e-O /u-k \J t/lilU
i/i &"*-h s~-~ 'i-f.^-'nj fh&L-P — ; • ‘ . ^ >3
I frih^ ■ v / / ii /tf 2 //>v /ft f&&tu f?//)s /v-
■ / &, £?t£ Al 21 22 ^ /^^yj J} (X^ / /
H^f fyl ^ A t/ t /t^t - 5 -w /ft/ / l'/^t i v ■’
/ 4 M J 1 dis-t-"-^ - Ou, —* \Jdiwt- /Ls^l. t
^Viu^Z-e-v (✓rvL^et £&/w '0/^v\JLs '— Ly
\^fht i. ) K ^ ij £ '? J f£~> Ci'J >: Mx-t, K lUi
V-C dLLfr luJ\x.xy (' _ J i t-£! e> /J ^(M.,;
/? ^'itxf-C f2 L-fi'- —- Cl**-d C&zx^f-v^ ' ^..
*VN>
( 27 )
2. Keep down inflammation by anti phlogistic s, both local and general Dress
lightly, &c.
3* In severe contusions, it i$ often necessary, at first to stimulate the patient,
but this should only be done when tire prostration is great.
4. After the inflammation becomes chronic, or when the blood ie not readily
absorbed, use stimulating frictions, bandages, &c.
PUNCTURED WOUNDS.
Definition. .
Causes.
Characteristics »
Prognosis.
Treadme at .—Gen era I in dicat ion,
PENETRATING WOUNDS.
Definition*
Carnes.
Char a cterist ice ,
Prognosis.
Treat ment. —Ge n eral indications. ^
POISONED WOUNDS.
Definition.
Causes',
Char acts ristics ,
Prognosis,
Treatment .'—-Depends on the character of the cause.
1. When they are produced by the stings of insects, the remedies are.— cold
applications, volatile alkali, saline solutions to the part affected ; and occasion¬
ally bleeding, diet, and purgatives are required.
2. When they are produced by the bites of venomous or rabid animals, the
remedies are a ligature above the wound, excision of the part, capping or suc¬
tion of the wound, caustics, poultices } and often constitutional remedies ? accord¬
ing to the condition of the patient.
3. Dissecting wounds are best treated by s-action, caustics, leeches, a Mister
above the wound, a poultice or cold to the part , and constitutional remedies,
according to circumstances.
Definition,
Causes.
Time of appearance after the recepden of the injury.
Symptoms.
Pathology *
Prognosis.
Diagnosis.
Treatment.
( 28 )
GUN-SHOT WOUNDS.
pi Definition*
£ Varieties,
J Characteristics, —Constitutional and local.
Wind wounds * — How produced.
€ &u?i-$hQt -wounds 'usually contain foreign bodies*
Pathology of the wound*
Prognosis. t
-Treatment.— Several indications. Modified by nature of wound.
J . Attention to general condition of patient at the time the wound is received,
i. Arrest the hemorrhage where it exists,
f ; i- Examine wound,
4. Remove foreign bodies, if possible.
5. Dress the wound. Cold applications should first be tried, and if these fail
to afford relief, apply warm or hot.
f/ G. Guard against secondary hemorrhage,
7, Prevent the formation of pus.
. / '8. Prevent inflammation if necessary by antiphlogistic!.
i U s "PP or t the genera) health, if necessary after suppuration is established.
,A0. Heal sinuses.
$
//■'/ / *«-T -
rjjjjf ^ /Tt'C * 1 Z* £l--/’ / '^ £/) J*bysf — £c~ *
A^y ^ /%***-* 6l*s$ £$ 4$'us£t4W ^/f rP ^^l /&- $!* *- * ^
$SFPt Px. j y& C&-C*~ /AV ^ / ; ♦- t^Kst^** /lUl
\/ ^ ^ <-
A • & ^{/^V - y / / * V . ■? c/>
/t -L. : j> ll A: ^fc' JU J A- ^* ?t-' I
iSt ^<- Z 77 ^ &l/<J r &A^L*t (/J^t-x ~ ^
^y ^ ~~ / * f ■ c ^ '-- ^^ f*/ * i ^ ^t^CAc
Al iy r ^ h &$■ -t* ^
2-~S* i
f~ - t-wA- A r ^ ~ '
A4v l 1 A tixLt- V,-A /t^>
, / / ', / / ‘ / v , ,
M
J/ +• ; t. • r. _ . ; M i ’ , • .
tj- tl> A /•'•"'
A ■ £ ■ ■■' Mi-
U^yl <A' ^
* £-1— /C /V
' - t . i^w£ A
/| v- Z 1 J Z| /
/| A'U/i-V a ;/4 A : # c
^ / /? . / -i /
/7 / aA^ -
yJ^-Oi. tr f ■} III;. *; • / - A ’
■) /ln ' \ fK-l
■ .
U A
Mi- ft. l i.-v a. i C
UL ^j /$ t j *J *-
l <-
' /*
tv /A^
i
• ln-'>\s- £\..
/
/'fa
j j *
'-*■ V Mt-U'?-' ^
U\ ft
: A* /?
AA/ :t tt. ^
l/ki
l^ A^t $C / V -t'W' v
i^y(-C tf .
Mvv V' l-Ky,-,
✓t -1 /
v V 'A /•• ■ i
/■ •
l-C«- »0frV i «
v - ,AA
Ai f /^
A
^ /iAVCi
f lc/'jL>ysi-C
<A ■
A 1 -
/C
f vt^
y n*~ c a.^ ft"*cl faA fichtct Zfo I!-.<((
A - ^ - H Z /-Kvi) f*vo ArAj, A-v c-t* ^
3--‘, / f^tCj /d*ucj*/jit u OPi^ —
^ A //. •_ •/*. ’ Cav^,
i f- A/t/YxM
'/ I
^ /^h_^ £ k^ b^^-^zs-'J Lj^CJ
£r?dp^ filtU- , V i/ £ Ju^ fj ' C * ' *• v ' C £/ 1 ^
/ft
I
, , / ^ ^ ^ /^ y^
Ci/H/(r-’y*%i.-\. ,^t *..‘ /■ ( 11
I
vt . . j% 4 r y .
^ tL \ <- f yj^b-*-*«. >> W rxvi y - C— _ ffrit t w , / /
_, '-^4 yi £ t
t-i-^ / / *\^/j[^^^c--J > A/
i j At- y ht- - y/^-t. y
_ I 4 !-Ih/{ ■'•>■- r $■ tx.jfi 4 t<; c ^ v /"' .-i-1-t v . .■
I ^
.M 1
*Lf'' / tbx. ■; i : Ct,.{'i t,*~c , 4)1 , b A-t
' /r " * * / S t ' y ' *
^ // J l Wfe* -, / A / /> * ^
r£
:s>
/• t £-••* , ,‘V ' ■ / J . / c... ;.'
hft ^di •>> ZZ^cJ 4{ , i l
iT yt < ‘ V
fs
4
I B&dO'ru A-.y;
1
’ / -.v , / ' 1 t^Tt .a , •
; . //•,<_
/
Tt^y - //A. t*s*.-i -■- - .f^-u pty ^/|,-
- y«/‘/ (fat) / _ /^ ■-' ■ >-^ r -~~
v/ /?v*^^Ldc A-u* ^ (fJofa*
/t-’'V~<^A, A'i<T
•*)'*' t ( > Ct,'i ~. ->/
I jy& x/'l i t/~i vlnj - y (/;; tv L-:. fC
*
■ wr
y 7 '/> ,
'b tt io- ! \- , -
A
v-A-
-.; ; : ■ ■-- - If 6&*X*-Aa*cIL . ’■ ^ '
iMj* K -' v.vj . M - ‘ •
*a l Ca- ixG,
'/
V .K.
!
c^c£cZuU<C' i ^ ~ , },4t^^4^\
I i /7viW~ln,'-4 'A Jir dC /}lyhi.tr J ~, J., v^y~ u ut) Ctrt—
I ^ T^h-C t*^iL*rfy (J) /
^ t, \^j£. 0/ / 4p£^£ forCip'*} / $/& Jf. /
0^^-£yfk £$ 4y.^ £3u*^D Arfji* f
£/h_ -0 \m /-J ^ /^M/r
/&■- !p ^" '$-&C*£> <i-W* w **-*—^*2 £,&
/y_ tA ^g^C A v < ^ ^ * <&* £P -&*£ fU4&** ^ c^-t .
^sy-&zd^ Jq #xt-
-yUa>4 £$&* d) /hu^i^£ &r
/ ^V? 1 u , ^ - J ^ {j^'tC/L ^ ^ ^ lA&dxs&^7 p> £$^LAst*^i- (Lj j
Ai^Si^r fr/tH&LjQ d&&** ~ ^ /•*>> Ai-
^ ^£-7') C* ^ *»l ^ o0y£y {'f t w * // % „ i.
Tfa] jfczZg, ft> *}/&-/•
ly fcy$?+i*y t*g7 '^ c ^-i-j|^' £*-<yy "- ft~<^
£^ ^ &£ r l- *-n+' jfe'tfi c£^k^ £*i* Cv'/^ e^i w /t^,
/a£>-;S /'-■ 7 \-- , *v' /14. •fat.C*tZt**t'-t*J hiryl-t .—«? ^ °7 &y-F*r 1
/^U - pMr\Jhy ,6-< ?&* tj %&$*?' '^jj
^ * i' \yyt V''^\^ d /~J <7\^£t *t^ t A> " ■
- - IllAS^L-t^O __ ks-ca^4_j^ y~ *: < : >■ = - ; l ^ C - __
^5 ^ fpmtt. (Jt H4r*+~x}^ U*iMr A^&y [.. L , f'W
"- t^y uW'v / /t '■• e*
b&’C't'V (m-\ -v J f t’ J,t?) ^ui-t^pp^ Ity &
^-sz~ J fiJi ^y71 &<f f~^
CtTp i*s*>'(Zs (yi$ |v^v [/f— iS7 ft- [vc y *~ * ,
^ ^rvw-|<i/< >KJ J<^>1 \JmLl- -_ ^ jLtsvJt&O. j
vwf 4^4 Lf c^u-a^ L^a^yy- iA Im^Jl
ct^
i? 0 ^-
; r ^v
4&4$U
-l*H^
%
/b-tpd ~~ 1 'SasL £+>i*y^—4 /ju,
AM w <- ^ i> ft^^C
(iCt/w' i OC^S-t^tli _
- r
I (f A A» v A <sfcy;.: Ct-vs-wd^ tfc C~.(-'r~ to ^ t a ? S%4-+-*~#r i
■ ' k*L4%.C^£t+ 4 A^-0 ^ J ~~t£ g£ '
~jL A &r % si fjt_s aCt&a, /I =w .H/H * A#
'A^v- !f
Za hr $ ci r IsU&'ftrM —
T&H*0 •* A*«
Hi rl~ /He- At >• W 4*?'*-^ c^Ac
Jjj y6 /jt **■+*£ P'h ■■/ A»<vt«P ^■ <,i ^
mbr&Z'i' c*'
■**—
^ /^rv /jh^ ^cmm/
-P >£ ? y Hi ^ t
'tfiO , Att/vCt (yt^PvA), Ut-u (/}Vfr*s'/& ,
Q*- j^?/ VUv<
tj a / t p
I [ #* 1 ** £ c& i ' /r,* ^ — AdfiMt 1
i
..
SECOND DIVISION, OR DISEASES 03? THE
TISSUES.
I. DISEASES OF THE BONES.
General Remarks,
Bones most ltaele to disease.
Causes of Disease.
Effects on Constitution.
Classification.— -All diseases of the bones may be ranged
1. The non-malignant diseases.
2. The malignant diseases.
3. Wounds and fractures of bones, and their occasional results.
First head, or son-malignant diseases.
a. Neuralgia.
b. Atrophy.
c . Hypertrophy.
d. Osteitis.
e. Abscess.
/. Ulceration.
g. Necrosis.
4. Mollities ossium.
i. Fragilitas ossium.
/. Rachitis.
k. Tubercle in bone.
l. Osseous aneurism.
in. Exostosis.
n. Hydatid encysted tumor.
o. Serous encysted tumor, or spina ventosa.
Second head, or malignant; diseases.
a. Osteo-sarcoma.
b. Medullary sarcoma.
c. Fibrous sarcoma.
d. Fungus Hematodes.
e. Melanosis.
First Head .
I. NEURALGIA.
Diagnosis,
Causes.
Prognosis.
Diagnosis.
Trs&tm&nt.
( 30 )
II ATROPHY OF BONE.
Definition.
Varieties.
Causes —-1, diseases of various kinds; 3, retardation of struct oral growth ■
3 3 old age.
hffect upon the strength of the hone*
Appearance of the bone*
Analysis of atrophied bone.
Treatment.
hi. hypertrophy.
D efin itio n.
Varieties-
Causes —1, exercise; 2, excessive nutrition in different bones; 3, inflam-
. matron; 4, degeneration of soft deposits upon bone, the result of periosteal
inflammation*
Effect upon the strength of the bone.
Symptoms.
Appearance of hone.
Treatptint*
IV. OSTEITIS,
Definition ,
Question of its possible occurrence.
Varieties — U Acute, 2. Chronic.
Persons most liable .
Bones most frequently attached.
Canoes —1. Constitutional 2 . Local
Symptoms.
Uiaguosis —May be confounded most readily with periostitis and endostitis
Prognosis.
mortification' 0 ^— Reso!lttion) atro P h >* hypertrophy, suppuration, ulceration,
Dissection.
Treatment.— Depends on variety of inflammation, its intensity, and the bone
billed'^ I he remed)es r «5" ir ed may be cither general or local, or both com-
V. ABSCESS IN BONE.
location of matter*
Causes*
Symptoms,
Diagnosis.
Prognosis.
Dissection,
Treatment.
VI. CARIES, OR ULCERATION IN BONE,
Definition.
Confusion among authors as to its precise nature.
Bones most liable to be involved*
I ft ft-'f-- j — j
| /rZ"&A //! Ctft
Cl'Vii'i t iLLsC ^V‘>(_^f CX'lsC / 7ft4 / f<J
I ftyL^Cftft /i^iTiu W $£l* 4-*t~&rd4*** .f
| /^4 A^ Ayfaftz*# g// f ^ u <r v f ^ 7? ^/W ,
/"/• ; /0/'■>*-'■<—•', Sic ?-ts-c^s L™*'i4Lu, &i«,
i ^/^_y 1 '-- '~---C' L'CS— C— , _ / -vl. . _ - F y'^s f ^ ■- o - i— />**•' r /*~C4^y~
.pd'i^C^d dtf^yr^-C £ 4 xftt^ ~~ .^• ^ • ' - AA
ft t v eft i^- / ^OAjC J ^
>. ^1/? ^n v y /i / <? .d t/> £-> J^-L*4r&sf£X /7yL (ft4 .
l ^' tw ^ lj l\\*. ( V A4 fc v 4<^
^£U^u t ft i- ftcci •
fiftft/ 1 finnr > ■' u t l \Y-' A-l . . w . — ftt-Cift" j-fti- yUu,
| Jy'l^^' j^-idst ij tsl,^ J tftft
ftp—ftt-'L , /C Ct- <fer f / J <3 ,i!<;
ft~rsi/si . sCn' c-i-LO — C-Lftftfti «--' 'A
^ ^ / H : .ft J / >J ft l
4 2£\- i ft jin?- uftyp , ftf-uA Ajuflcft
ft :. ■
I ft-^ tcu^tZij ) i {« i 1 '. // p ^y ((yisv^ift fcw ft /<jt’ '■’
ft /- r -r‘7>^/ Sl-C-iisfe £w ft/yy-vy^ \.^0 ♦— ^ /■{ fft *t/f,
Av-'/'i l'7> ftc-\. jufti - y/l-vvi^/ —S f^V UA^/-
| : -<zft4'r j-uftd U ftrrul rtu< f c fta>V'(j^
yy^ui^duy *^T\ L'^vi' — A
VH .-1'^ /(V A , • • ■-X —. •• 'W
tT ji- iCvi i C Jrt^U ft ft
Jvf’Vl- r?Tvti X- 0-6 iM, f(. i* - -A *'Cfl-Jj^U-Ltft ^4
y^ ,o J , , < f . j ! 1 _
^' w 'l I'WlAAA VV\ | vJ^y\_ V - '. ' » ■ ■ ■ -C O '
lrr*-K. A> *- / i ('Vv ti., L §M. /,;•
/. ; b {v\ <i-uL u>V i^.- V /j’Jvw f'C ^ , Xj^. .>rvu.i J v
-«£^x ^ 'j£ ■Kt'-L A \'' riv > > ! ij& \ s \ /:
jtbrtrfa 'jXx JUfaj-h Iff (j l (W K. 64 a4- «7 >■ , >
YKt; iWN.a^tt -tjf )p (>vv v- ^ /1 1 t l
frvf^V "Tvc /.Av'iv u, *<f frw A-|i: r ( -
Mm <>J rr-c ImaU- iu iA ^u.. In c -‘ fyc/f
cv^vjl feu, t^MA tt \J / l £{1 t x J ( lt | (>
Bp yyv (/^ **Lusv £t&VL> 1 (hjjsHfScJj a 'Mini
oJb&L-oLZ ^ t^j-i tf.<J
t Ai^aUtclS^. r ft ^tZfcyXo
L t'~i \ - T\ - £ * k * £ J ft'...'' 1 £ *\ . ''^*"'
* <fyfZZZ\ -#cc itv>^ £<J'f ■. ^ :
.,„. / Q. ■
%" --i?rU /- I*-*.'
4E( i n t,
'^y ^ f‘ ,; 1 ‘ ‘ ' *’f /n-t^C £- (J , ,,,. ' • /./ ■ c--
V- / 1 / » ns £-'A it > i, -■ /
JF
1 a • ooT-c_ -jL-tJ.h- r _...,
|C, ^ <Ljj4 pulUtitZi ~,/
'/ '■•*'• • ' t /i*rijZc * - v *\
'i' y • a/ i * V/ *-<^^u4».»..
ia . ^ - /
p 4 ~ r r - ' ^ V / . ; _ :■ ^
> ‘ jhCCu>^+ ? '~t/lr 0-> v. ^-’ ^ / x/CtSp-CJ;
■' y <2^- x.X^ <a£; v' * - > .-
y
/^£- tAv j. f <£t J^7 j , w v/i
'/V / ><S 'sf*..4r *£•{ £ (. 4 / < "/ • f . >. •'
/: t 1
f
■ F
;>*- t ni^r r ■.»■'■■
Ef i J «- * '■ • - /1 w, -4 4-P 7 t-y
4- ;,,A
7
/T
< * 1 .
V|
f
1 * V -.)• j a ■. . fe.*- ^..-«. /^_ u i ^V" v
A. i'' V- t - X ; t\U . •' ~ '
r rt - 1
• m y/
4Jr?-f
tT*- to
^ —i f ; /-*0
f p > 1 , •' f ■ i * (|
C^tc( A
f fit :^( ’L-^t'^-Lsf iZ A^is^t . '7 ^ ^—
■ i r.:'- r -y: :-^y,-- Z^t i-v 1 - ._ y ftytt
. •' ’ >£*/ t'v* .jhtsv'l''S f^/.i i,/-t r ■ i- Z Hs’tZL't,’i <^ { , t. t /(Key c?]h (
^ Jh£uftZ\. r fcltty -./:.' : ■ v / /< . 'Vi.** £j.
. ; ' ‘l? / ^ Vm|
*?£ fr-t^ ) i 'C't-i U '*^- ./"i-Kr iU'i >1
J A - V ./ / / A
M) & *
.\t J > .
/u a i 'vivV?
£ W ‘C f <• “• ' ^
//w
:. i’fu't' u rfit; VU
••; tJ- , v^J |
J,
(a > ;'o> 0- /■
PwlAh /-n. £toG?£.<£c //u^iVVC A
tf^a
A3-'-L-^ Cr-£r lA^Vf, W i'cXcV /t <J4-1 /..«*♦*• u vf_£ ••/
<*JLJt .- - j ■ \ ,' f- ; ■ ■' - (fyn\£^ •
Cfi^ACc£\ -Jj ill{.i,\ a ' .*—*► (Jjj f
jw O'Ka^. frloCu* far . ^“,f'.:./v^q
/~ fi t cj- itZ-t ’{~f - &/'£-) t- . v jALA- ,0, r jv^XcA
AW IjffiAZt u4' (''U, M
fas sj U - Ob-!j~-9ufa^ <y* h /%£, f
/ ry r yy>V^ ;*• .; / t ■
" Jl:H (y /''\Vt '_.C- - S-Ay }\.\^ ji> ij
/.- ' .• s
* T7
>4
, t i- , r
y '/^Q> ^ ' <'• / / y (fji.il L
tU'L -i- ^ j u t fjn-y^/f^ ^Al L' C-ttt)
hfr uUw ^ 5 ., /
^ ^ c. ^ / W-' i- .. /f/hxjui^ i v ;
-' j "S r
' t ry^A i '~^ r ’ /
/tet. ■ JjJjAtf's* , Ly. ^ oJy^ A''* $ s-8 ljJy>.i
1 ■ " : : j 1 - ’. «*- o C/
tL4
. . ,-t_>
a
^ /hst' ^ tt
/& h*~4, tfvr /ht.fpfac* >f^(44(. ^
^ ^ ^ LisO^l. *£c<,€yh.
tWhr*. Uc #T C4rCiL } €i4tUCtZ^
fit £*** A>^/
ftf AceC'h /n.^^L
a**** Jttd#^ ^
$ AV*C /^H^t-'
&U*sCt ^h/ /«v/ 4jL4r***< /^t^.
/ ,. <r , «? /l ~**'£j*^*. CUsf~
fin..
__^., ^>V£. >‘-V- / 4. t. Z.-
hx O'ICL tLcfc/K,, Ji~/?>
yf, / /
£
Vn
- . , - 'J'tf.UC- /)
xiuj ' finx krUu. % Stcj 0 yi ^j^
J^Virtf /- / iTt-wuZ^ l ^ ^ i /} / // /> ► / , .y
>! /•)> vt to" ^W*v/-7-‘'»v t ■' rji^K />i. • /• *■ .: / ^
-/ L
/? *%■•
’/Vk 4r ^ Cic (.) • Cn^-j
‘ ^ <v&
<^W Pt /U'l , /}
('^'.it4 V/x t ' ' j t,‘c/4 &■ j-i^ C< ./') t
^ i; <_/'.t4 I't- UK't^' ^v-/) ^Vy ^ jfouA^A
' of &jji Ati $ a'V< ^ .'
cA /'v£'tv>-*A — —
1 ' ■( A-m^ /U <‘J /St is w
(1) tvi /^ Vu i jrV^ -Gt/ftv ^ ^
C^/V"
fi t <t 1 livw9-< ui tev^
jn tta iv OcC , 3 (W\vtc-Uc — ftM fp i,4/\nJw&
I’-'Miw . ?\v V' yV v \A^“^ ^ 1 ,
D 4v4W~j
[h/V^c f {ksfcUt^t is-^p, _ /i# /r
Wi/pfc, &A*A fcp'tCrf t Ast*/f&. v. / i ^ u tM'irf'J/i.Pj
"feU.^, 4st*i ^sCaJ Ctc’tt,^- — '^vv2^'^Vr-6^
't^f CX^Ctt't/V MprV'C^i^
4jy^v*- ^a/W^<-t' v fUsCdCtd — i.£*fo A ItrtMs f'f'i- s- t |
&(/-d- 4 -jL ^£w 3 J" C-'ii^yUj «* /u^ if C Cl^aA /1
iasvU-- dwf 4'-^ — ^ kk ! 5 ^^
A/z>/c _ J \zAjbjfa*t*^y (AsAusifV*£C6
fyUo^C * /% ^ri:w <^£^ > th&tidU
£*£ MtcyC J+-, -nv^ui
j ^ /?vt i^aJt
/fee* fav»-c $ 'C&'ts*c cJ- ‘ - ff\Jj C?C*-
jlAsy f L pu $smi b£ ^ U'h ti 4U u4 ufj -
—£*■ {--■■{ O VV' j'^ — .' \-t> -*^r "Z'f ^ ' J ! \ C_ - ' - ' :-f ";
^h~ Wvvt^ —
Wvv'-- I'TA'.jC- £*~Ou 4 C(,vV It-l j ft
jfcx JAua* 0.& w^c ‘ PCZt'a * * flfy
fAfjo /i^a/t£fU t / tf 4 'A , U V U*- /( t -i- L i, {< ,''*>* '
'l«+4*
/Mej f>: - fit At? fauA*'~
fy^YY* &-A > r ( ccA) 0 zo^-l- /''Vf^itiuC
■ *■ 1 t*0 l H^fec* i/^ j -■-'/ C t ~ C A ~'
(nrt^^foxi.'iA-' 'j— Lc. VW ^^XMy
/r i i^A v-t L v j?
( 31 )
Varieties — Simple, syphilitic, strumous, malignant, &c.
Causes. — 1 . Constitutional. 2. Local. The seat of the disease, when
constitutional causes operate in its production, is modified very much by the
character of the cause.
Symptoms. —Constitutional and local. Modified by the cause, stage, location,
and extent of the disease. Usually three stages.
Diagnosis.
Prognosis. —Often confounded with osteitis, periostitis, endostitis, necrosis.
Dissection.
Chemical analysis.
Treatment. —Both constitutional and local remedies will usually be required,
and these must be modified to suit the stage, intensity, and cause of the disease.
In the first stage , antiphlogistics are usually required. In the second stage ,
emollients or stimulants, to change the character of the ulcer, are generally
employed. In the third , we must either cut out the diseased bone , destroy its
vitality , or remove the limb.
The cause must always be removed, if possible ; and if specific in its cha¬
racter, specific remedies or alteratives are to be employed.
VII. NECROSIS.
Definition.
Confusion among authors as to its precise character _Louis w r as the first to
describe it accurately.
Bones most liable.
Causes. — 1 . Constitutional. 2. Local. Most of these operate through the
medium of the periosteum, either internal or external. Some effect the bone
primarily.
Remarks in reference to the influence of the periosteum.
Varieties — 1 . External. 2. Internal. 3. Complete.
Symptoms .— Constitutional and local. Often obscure. We have usually
three distinct stages in the progress of the disease.
1. The inflammatory stage.
2. The stage of suppuration and detachment.
3 The stage of reparation.
In external or superficial necrosis , the local symptoms, in theirs* stage , are
a dull or acute pain, soon succeeded by a flattish tumour, in which fluctuation
is after a time observed. The skin next changes its color, ulcerates, and pus
is discharged. There is always more or less fever.
In the second stage , the swelling diminishes in size, the bone is felt bare ,
rough , or smooth, according to the nature of the action preceding its death, often
rings when struck, and when we can see it is either whiter ox darker than natu¬
ral. The pus discharged is either laudable or unhealthy. There is sometimes
inflammatory fever in this stage, but often w f e have hectic. The bone is
gradually loosened and detached by a process termed “ exfoliation ,” which is
very analogous to sloughing of the soft parts
In the-thi>d stage, the local symptoms become milder, the constitution im¬
proves, and the new' bone is formed.
In internal or complete necrosis , all the symptoms are more severe ; and in
in external
necrosis.
Process of separation described*
Manner in which the sequestrum or dead bone is disposed of— Depends u^ou
its being external t internal or complete.
Process of reparation described - Yaries in the different kinds of necrosis.
Character of the new bone and its various stages of organization.
Cloaca; fbrmedj shape, &c.
Prognosis.
Diagnosis.
Treatment - Gene ral ind ication s.
1 Remove the causes.
2. Palliate the symptoms.
3. Remove the dead bone after its detachment, and sometimes detach it with
our instruments.
4. Treat the limb, where the entire shaft of the bone has been destroyed, as
you would a fracture of the same part, until the new bone is sufficiently fum.
VIII. MOLLITIES OSSICM.
Definition.
Causes.
Persons most liable to be attacked.
Symptoms.
Prognosis*
Diagnosis.
Pathology.
Treatment.
IX. FRAGI LITAS OSSIUM,
Defnitioji,
Causes*
Persons most liable to be attacked.
Symptoms .
Prognosis.
Diagnosis.
Pathology*
Treatment ♦
X. RACHITIS.
Definition*
Causes.
\
Persons most liable to be attacked.
Symptoms *
Diagnosis.
Prognosis.
Pathology.
Treatment*
Cx/ywj» <*-*4~ /^r-^- c^'J- ’^j ^.^ >-h. /^- t/ ^f £»n* ^-^xTt-
$ts / UA~cs'l'''{' C*. £/Q.is\ '- i A'*'- / i,'-- / lL / j'i tsy IzVA^'f- -fa*
(fr\Ai Ih. ca^c^Uux^ % 'tm Vi^v ! tf {&k t<4' tA/i/ti
aw /-^tX— j- £rttA*y<— 6!r0w j
/#fc> W jx^ i (X\', \x) [a iaX^*
frkA j±*>- /rr*us fry'll j rrH/~ ij
rr^ f > txn^ ; t J JisLtyCt ,^V^c (jYy^t. Cd iRLrtim
/fj ky & CcCox6x^a^ UhUo
— orf»{ k\M*y ihC^YiC i
h^u^yjx’ (aas* 3 - j h'tAv^ Js, y i'- v'X^-c,
/VWU^M- c^-'f 0-yt/p C*-<^2} ifcj$. (y\
K ^ Oy^^cSw L r< f< t~u*~ 6m^ cy &$ ^ i,^v i a
/hr t,^vc ii^yt cL*$ (y^<cU
i)M,rrv ^ /r 't/ c j - ^Hyy^-Cci i t/ ’InjW
~fcoCt (jc^^ f i.*j —
v. 'yt^-vu^vv^” /{vWc
#4ce> 0Lc-&d /> /»w ■utvu^r, /»i7^W^fvc
t *■”6' ^ ar <•
1^1l(/£ -t| t"vi-v (2dAU> ^ UrtwOf*<» /x&h £-t-* f /fl
Ot^r-CfyJ.^ hv~-~'- CJ-'i if ‘ ' -O ^ «— facts
C C iXv4 *A„ ; / ij>
M ft&lfzFf Cl^ - 'CT /L**st r p (XCnJ\X ^ /f
i^rt6lA- 0 At'->\,c^
<•
r
( 33 )
XI, TUBERCLE IN BONE.
Varieties.— 1. Encysted tubercle* 2, Tubercular infiltration.
Characteristics of first form, or encysted tubercle,
jEffects on surrounding parts.
Similarity between encysted tubercle in lone , and tubercle in other tissues*—
In bone, as in the lungs, &c., the crude tubercle proceeds from the semi-trans¬
parent gray granulation^ of Laenraec and others.
Process of reparation after softening of the tubercle.
Tubercular pouches.
Results of these j collections.* —4. They may be absorbed. 2* They may cause
suppuration and ulceration in the bone. 3. They may serve as the nidus of
new tubercles.
Stages in the development and maturation of encysted tubercle.
1. $e m i-tra ns pa ren t gray gra nula tions.
2. Crude, opaque, encysted tubercle.
3. Bony excavation, loss of substance in the bone.
4. Evacuation of the tubercular cavity.
5. Hypertrophy of the cyst, obliteration of the cavity, recovery, (Nekton )
Characteristics of second form, or tubercular infiltration.— This may exist
alone, or in connection with the other variety. It usually presents two different
conditions.
1 . Sm^’transparent infiltration.
2, Puri form or opaque infiltration*
Difference between the two.
Effects on surrounding pari**— Invariably causes necrosis of the part
attacked, and also produces purulent infiltration. It may also occasion tuber¬
cular cysts, caries, &e.
Process of reparation after the bone is affected or destroyed.
Stages in the development and termination of this form of tubercle,
1. Semi-transparent gray infiltration.
2. Interstitial hypertrophy of the bony tissue, or ivory degeneration.
3. Purifbrm infiltration.
4. Necrosis of the infiltrated portion,
5. Sequestration—foreign body—(Nekton.)
Diagnosis of tubercle in bone.
Prognosis.
Seat of the disease*
Persons most liable,
Diseases produced by these tubercular deposits.
1. Certain forms of diseased spine
2. Certain forms of white swelling.
3. Certain diseases of the smaller joints*
4. Certain diseases of the inner ear.
3
I 7 St. Mary’s TTospttat
Mejukjal Library
( 34 )
XII. OSSEOUS ANEURISM.
Definition.
History*
Causes.
Location.
Persons most liable,
Symptoms.
Effects on adjacent parts.
2diagnosis*
Prognosis*
Dissection*
Treatment,
XIIL EXOSTOSIS, OH SIMPLE BONY TUMOURS.
D efiritio n.
Ola ss iff eat io ?i.
T Those whicb originate in the periosteum, or suh-periosteal cellular tissue,
and may be termed external periosteal^ or peripheral.
2. Those which originate in the substance of the bone, ox in its cavity, and
may be called internal or parenchymatous.
3. The cartilaginous.
4. The ivory-like
5. General Exostosis involving the entire bone.
6. Partial Exostosis, when the disease is confined to a portion of the bone.
Mode of development of the periosteal tumours.
Mode of development of ike parenchymatous tumours.
Liability —Some bones more frequently attacked than others.
Humber of tumours .
Size of tu-mo ur.
Color of tumour,
I'ornt of tumour
Causes of disease.
. nip toms . -Vary with the cause f structure t and shape of tumour, its loca¬
tion^ and the rapidity with which it grows.
Effects on adjacent parts.
Diagnosis.
Prognosis*
Terminations. —1 Resolution, 2. Conversion into other tissues* 3. Necrosis,
4, Suppuration*
Treatment. —l. Medical. 2, Surgical,
XIV. HYDATID ENCYSTED TUMOUR OF BONE.
Definition.
Causes,
Eart of the bone most liable to be attached.
Effect upon the bone.
Diagnosis.
Prognosis.
Dissection.
Treatment.
K> Cl^VC4ir *
-- CA- C?(. Lr *
c ^ it-
sfafafo IfVht* fai* ~^fas /9K(.t^v-w &l ii!zj!
jj ,4 fafa c jl ftV (lii, i /~
-* a /'VVW
^#i^v ^ /L M-IKfa ' fitk/ts-* jU ~fe<?U krdfC (fa
ftA&M, fa &/'-?' r ~ f ~~ Q J 2£' f^shl^yr — £3 / >~
yi*//- fo-wc( ff$ntf frfTt'/fa,S^ £2k*.&C
U» - /3 - JJ 6u6uj&C ^
I fat ^L£. A t ife; ^ ^
JgQ-'l /-&>$?- C — £t fij L &-tj£jtr i ' O ^tstrir^ ,
Miy)yL- s^U ^t-A-K^-Ci £, ^ I'/i^tf- /;6i-
fyqAr C/J't /^*C / )‘1~-C - J $■*• / Cbd C t- 6 '-'*■■'< ^Vi^i V' :'.'.'
^ /y lu£tfa>^/}y ~tj
££sts*~^ t ’t* h‘
^47 u /*-^K f* X ^ J
Li^k*
^ fc- .1 ; ^ ^S-* r< *
y ^ -'^< '•'' ■ ' {f' X? r **/ /*' / » • - y
x/v^ &i-t~- b > &y b?~c,
Sit /tf~hj!-y d&*~ 4-
fac -l d^~il Ai- .
rfse^r-di. - f by C/t iff J t-t, Si'<*-*€ Ce.-e.i.ifs,.
/•£&?&?; S^V/h-H.* 4^/5/,, /ff/V
fanr^W-Tl* ♦v Ch^... f £b*«»e) 4'^'VW‘W
4> 0^ yt/^' , €^ ^ — ^ St f /»r ie~- 4Z*~ /*• ■££ S * 4 f -sj
y '— — dfa+*-£ / -CAsis'^'S —
/ {/Xfai y ycn^ pY-sf —-
lls^m/i- . 4 /'br fa? f jfeiZJLc, i'fai ttf
(fai'VT /i vt ■ /fa t ^ — /tVG&^rt-. fa'-C^eJy J
fadUMST b,J- Lc ifaLaU —
rjx^ji. c^i /j *..£.4^ //■ / ^4*.
Ah; |/[^y 4
_ i^L ^po by /'*-^«— 'L^ / fr^ ( j- )
(Z\ i d ^ &^UtTP>i*c, (_j _.
/h*> /1 ^ 7 , „ *t-j- /t^j^ /*- J" /g,
*4*tur „#a***^ ^0 a /UU^
SD )it'\*-L> £*/~Kt>i4s y>xt'tf'£v*~<f £-y~ jisyy** £ /\-p
!p>Cif>rx -y -uX y y ,Lst> £.4, /^" iw(St^v, _
^KLc- ^«rtwiTn-** sh-*.■/^.+
C/i^ / C^-^y - ^^.<LO
&*+? Oc-eC /t4/c &/■&&' _ ficp-jt-
9y A C% Sfa ftf-i » _ t,? '//{%.-
d*U- (ff t P* r jf~* y /%7 fe oU^
r Ct- f fi .U^ _ 3T~Plr '<f £1t-~£
///>>-« / CU*. t *4
TTTT^s*-' 0,44,4 a. i+rtXy 4tz ^fcvvv £V fij i,
^W- A &snv'LLcu\ hi M^v\
~!\ fafwiiC <U'I fjJJ (jy Q^/[ ),-u
/•vv^/- d 1*£.W Cys^fyJjU^tyc 6u ^ £u4
til ^ tv i fjfl J p—, ftw/ ^
// ^ l J l 'JS^v^ , 6*X J
-bu t\^\ir< K^iV^mJL -ts^tv£o {u
~ ^0 CtA/pp~ cJL}
U tifrlte' e-t-t-i" B?-t
* J/fi-j'n^*-^ ^/^L. (b^odfUb £;-.<-4/ Xa «
<$&€- —• />u 4 *“ /;<- dfliLt u —
A-Pv- &( &*-t '*)\, r P~£s\r ^Cf A*V
j'l/fo A £A -1^ — dlr l-OW&’lj //i
fo* ;d< 6ur\^L l-S'l i-%Ct&* ■* 4*dt%£ //Vt"^>*/’’ /v
. dh^rfdctd-j u*?ie 4 UfiU
^ OCtAr- /U-y^dedC A // /
tj £&* &lhv G&spli ^Ln^C QtHf u-Uj
'£ hs-t/fh,+**- / l €'f'*4-i t. j't a ■
#J ic /t 6 / c /dJ Jdu» ■£-; /'P^dZc d d'iv li^t .
* tlfcO ^^pUd^Ud <zti* I 'c C A-’w
Ct t!i'h
Jf-j X-A^^t-W£ {7?- id ‘ * idfv) ^fvi,J
X Z'—- )C^\ 4 !, % ^ / /i- * 3 fcv’
X*, «-t-J<2 d
f\^
r w t w v* ■ »■ • >^ - - / *
^drC tu &* W-)^ . ^'V#. <U>'.r-lv&M^
p^i tdA *'*■'•> X'H-*- i^jjs /fCZd
c & oyv*>$i£x> -4<3 /j/i rr^/ t 7 ^ m / / u l ' /
^ ^ ^O'" ^ f l'/* t v A^w / t'X- St'i-X- *>■ X* /k i ^,'V'
/’7^^6 L -*dt- hy JLfi r y t /( ll J'^AxXj^ iA- (l^ct-L
0Yz*rOjt.J */
^4 / y\ A > & h /li '- 'L d r H%. j\ Lj£. £ /ili —*• X i idlsht**-i-'
jPbA/t a- 'l$ r tntP'd * *- fJTv/tX9-6 ^
4~*~d~tr — aX ~pAA^^t"
/yk'tO" v £J n w4‘ jr'iA'^ (• It i,v ^) ^
(Ttrf ^l^vfOv^Vt X—
--a
ifa />wv-2
^ C( f ti/Th** ' / ^J~\sL ^ L tfjsii ^Wl/.
^*u v f/^t t $ » ^h#*i» ^v €& C< ( - <**•
■L* - <?'>*£'» tkj f *4 h <ff&-p&' - /££7
^vto/ 1 '- / (d<- i v tLJOi>
h\ p wx^y tc^x ,^.,/tivj
P*2 /fn vy — f)\^.c^ 1/ (x^
(hr
6<aU-1*
*x
NVU
&. >&£
if-C&JL
1lv<rt,i
^4 v ^
^-<n-frOv
i v^L*^v
>w
rf't'&L's. A-t friyj/Cr’Ct
(hC&rtA/>
4fa
* h A. ***C- ^ tfi^VV— j ^ ^c^t-t^-i-w-
C4i^(t^Z\yi (^0t\vw -<* j&**t'}/l ij
On* i,-> ,&2^vw (ktrCv-
fruj/ist jfi^i^aL fpfrxt^j f’Uf sJjy-A-
d/j h //sum &*i-P ____
!^l<£ <y rfchf&A u^ „
Af*"-* ^ /9V^4^/ //)\^4Jfaa //{-^
t*f* "-rfhzi J/ L >A /44 / • ; V^A
P tu rrTTt* f Uy
f & 1 ^ frpx*4s\wts* kUv /'L
fduct tr-y'O dt*. f c'4, ^
iJrmsv-(Id _ <£2-,..^ *x/,y,
'Xv / t/ h~r%^ n^c iufa putt.\ fljr-
lrt>H r?~£/Wv [vIZ,*.- oVouAfa IfaJ
ffaxt ^xl [ (l lM 1 •
( 35 )
✓
XV. SEROUS ENCYSTED TUMOUR OF THE
Definition.
Sy?ionymes -Spina ventosa, fibro* cellular tumour, wind ball,
Causes, " K
Pan of the bone most liable to be attacked '.
ITsnal situation of the tumour.
Effect upon the bom .
Size.
Symptoms. i
Diagnosis,
Prognosis,
Dissection.
Treatment.—IDs pends upon the size and location of the tumour, and the nature
of its contents. Several general methods.
1. Puncturing or simply opening the tumour,
2. Puncture followed by seton.
3. Puncture followed by stimulating fluids.
4. Removal of the semi-solid contents of the tumour, and pressure.
5. Removal of the tumour, or amputation of the limb when it occurs on an
extremity.
Second Head.
XVI. OSTEO-SARCOMA.
Definition.
Causes.— l. Constitutional. 2. Local.
Bones most frequently attacked.
Age at which it generally occurs .
Symptoms .
Diagnosis.
Prognosis.
Dissection.
Treatment -Re mo va 1. A mputat e at a j oint if possible.
XVII, MEDULLARY SARCOMA.
For the characteristics of this disease, see « Cancer.**
XVIII. FIBROUS SARCOMA.
For the characteristics of this disease , see chapter on diseases of the li Fibrous
Tissue,’ 3
XIX, FUNGUS HEM AT ODES,
For the characteristics of this disease, see << Cancer* 53
XX. MELANOSIS.
For the characteristics of this disease, see “ Cancer*’ 3
V
>
4 ^ ' 86 )
Third Head-
XXL WOUNDS OF BONE.
Definition, y
Causes. y/
Bones most usually involved*
^ Characteristics of wounds in bom.
Prognosis*
Diagnosis*
Process of union.
Treatment.
XXII, FRACTURES IN GENERAL.
Definition,
Causes, —1. Predisposing or remote, 2 . Proximate or efficient,
class may be subdivided into the local and general*
(1.) The local predisposing causes are_
a. The situation of a bone,
b. The function of a bone,
e. Some local disease.
. The general predisposing causes are— \
a. The diathesis of the individual.
A The disease of the individual,
c. The age.
d. The season of the year.
e. Sex
The first
^2.) The efficient causes of fracture are—
a. Muscular action.
h. External violence, directly or indirectly applied.
Bones most liable to fracture. Refer to statistical tables.
Classification of fractures,
The first division is based upon the relation of the solution of continuity to
the axis of the bone. Thus we have—
a , Transverse fracture,
&. Oblique or obtuse fracture.
c. Longitudinal or parallel fracture.
The second division is based upon the appearance of the fracture, which is
always modified by the kind of force producing the injury, and the bone involved.
Thus we have—
a. Fissures.
b. Stellated fracture,
c. Depressed or indented fracture.
The third division is based upon the displacements of the fragments. Thus
we have—
a. Longitudinal displacement) or shortened fracture.
b. Lateral displacement, or displacement in the diameter of the hone.
c. Rotatory displacement, or displacement in the circumference of the bone.
d. Angular displacement, or displacement in the direction of the bone,
e* Impacted fracture.
/ /yi^sZ'-gh$. C<i£6d — } v /i\,.tjf<?* &*~~~
/j /W< / ^^^7 ddiuiro /Uy du^ Un^<-y
^' / -/ j*ex*st ^ /^“/V#. i
AJ&syo , ^>rA f%H k^ A
6t^ s&c , ::l '•**'»■ c j ’■ y J&a.gzd' X^~
U"~ /1'1‘ls'i^ i '— ''4/l^t^l-t^*' d _ _
-d /j et~is/h l^u<£s/ SI f<- i,S J , y
ytsZJu, dUa^Lj /A/ _ 0*1- dj - ,
CY - y ^- ^ ‘ ■ aLi^K j> 7A« - t^t J
/ fc. OC*<£++ J> r ■ r — - ^ _ _ .
^^/Cc_ ^ J} S^ZOUty
ZC’**'*• £ ^' *t J? /A L ■ J fi
y 1 ^ ^ *1 g. (_ p t>. v - Jl ^ ^)
^ St~4r~~£,'-y _ c-ot..-j" f->
y|^ i 9~i-^'<Xs l/Jj d j {_s£ c^<-^y ^ ^
i-disis-g) .*- cs^"Ca. ”"■ “
tU&trC- - &*~d /'^ v *•*- «-^? ;: ? ^
fy-vnT^* L^ <f 6t, dCl*x/ 1 v i|^m. /v‘ ^
^ty> ‘■\st J v ^ H^*~ 6t v 7f *L / ^ ^-^“u <Y /a*
^ ^ £/ v p At^ j^-
- £ yi- £pjij #J ii^g*4*L Cl (
^ ^ ^/( /[ f v
CjyJ^tLy f*7 h/&£*^ni*u* £ : dA i~i--\,' ? i-
J&'J'Y l Jt A^ J fK't't ' J y J U^t / A> Js 0 X ■* * t--J ,
^ ^ ^ ^ *, ^ ^rT;^ u^ l n ^ ^ :
LLWu^ ^wc^_
ffc£/A i'.Ss\ (r^ 1^ <x^— \y^ J Ch- ^ t ^
; W J ~t_ , ?X l 1 ^'-'^ (j~^ — ! V '-J-
L ^V^x f ^ i/^^C (/y p UlA^ \a^ ■ ^ rt^l)
^Ucut-\^ly tj.iHj ty\v jy Caa. 4 4‘-U/U * Jv
/r>.-c, ^-eeU lw /L^fev r*-4~
d***> £$ f<4 tXf cJK C J'^4- &**£
jL/i,U } Cv^ c- 11 iytQ ^ Lfy
*t $Mj - h-*2 x — 444
/ /w JsL 4 L/i ^ r n L ^ 4^cL (asZX. fcV\j
l l 3 4^3 J-yl /<<-► tenAZ&ty du-L £/
f /r^/ ■ ^tr4sp j Cv^S)
IaaJ\- d K<- C j 1 s. w Isis-/ —
$^5-a£4-, (.x. /mv. tvnw^ kirtA £*4 £#y
U~ /ift^C^ ACdr-fa:^
ti-'
0~> /i..< e— ^A-/ '£— uW.w. -^ j
i r i /x,(j / x t~t 4 )
fi-- 4UoshuL .- 6L^Ua~u?oC
PKaYto, - c Wc' fh'-dfiXu
■ ■> ; iy/ /r ^ - 4 / ; dyCuvi -
'V *- b ^X. ^ - 4^Hyp - VJyfaH
'4'4y/A^ ■— X-i-v-i) ^ i -Xj (jlry^t-A 1/tSdi
4bAfly{yL~*4, l Wr L-Vv tvu*vL ( 1 )__,</■ V; ■ ' /v
^ hv( ~ /v^tZypli-4
, /t _ *4^_^a fj /vzU
i S-&L \ v 'wtcJ , X _- 4fctfwc6^t )\ l*^L
in-U LyU -b -f^UAyl'<Xl —. ./llVLi&i^
\ , l/p' 1 bv ixMyi^ — 6^- S^T^fZ^ *u
J^va^ rvyvv^uyK iruK^ ^ j.:\[Ar\j
(y — t^r'/Xv^ ^ Z<~-lsY-isZ\ , Ir, 'IrrwXpL
IaH/Ksu- (J , •' U 6tisV-n, AZ
■ />7^X &SX-0-
' \ \j. c) t/xzS^c^ .Z^wo rb^ A.a j
f - ^t) {^jJaz^s cjpUj*~ * tr 1
’/I Cf .y^fi'V\A-£<.~yi*, f\£t 0L-r^Ct-i) j
- *\ /<^i, *a.^. p--C £<yl* 1' 11 ^ t'T'Vv ^
£, ^ - 7A? , <^Vwv AX& o cLuM-A
cLa -^9 +-&j — J -r v.\ - b *
j-^jO^-^^i " Lt-^^- p*-' (^Z. f~L'tSTO
^ s~ — /y Z u
(r~ Oym&*v*~ &^ts\ O^i Zj Lrw~ M^fo
/j (Jj - T- Mr^
^ ■'<- Z 4 C-, 'l. -&
<£? ^ ^ lyUr^ tr (\jj bclTAZp,
^ZZ ^ ^ A ji) jo~c\ S-A C< * t^u, ■
/ ^V £c< /£t £t
At- r' — j~<\^A-> (j^ iI a t L<A (A tA/cuj
Ith> c- (/^tyy^C. /^*^oAAbc^ C i % ^ O—
^ JP)~TL*xA d C^c^x^ i L*~^~
- / A 7 fZz Jq %stzT AAAA^vl 4A Ui jtt; ( c^ i ^ ^
r* Ai 7 tZts<S — TTCt ^vI/LlA U' jrf C^ysA
AAv-^^yCt 7 IZt^A b\ [ t' V ^ ' j --h ^ZA-C'i'-^jf' ^
'A?.- A- pc>^u~ f)\x^M. uj^<-~'. '
C c Av 4 v c.a^^'S
Jh
$rti £
(P
Ui i
•fit# j
'p>t<*-3-t't)~C &0~tAA ~ti Pi
t>-t^Ais~ sU>A
terfesi-tt'K. &-< *d%«. &u*si*~e Co <-%c<-p
'■ + ktUs> - -- - * m Jr- / /; '
M‘
'4hH>+rU
U^uj-c jfcuC~ Sfep I f M
fr&- 4 %Pvt' $iC**t*utpL/! A
Cbt * i - '£* ) / A-<- fa £ijt* ,6-t*. ( \X j f.t J
fK( i^ /m. $aa 2 ppj*,t ^ J^ji
£-0 - 4g^fc /M Crfrf CipJ* asj ^ "
p Ctfv^jptJc Gi/t^eru^p^ t,at /l v P'i :> •
<^- { 0 kst^
eA^&pfc—■ ft- pePt^-j ww >owq
t{,)'\Lb CV-t •- /xvvv'- — Cuwt) '>t. 6 fi^-c^ v^tc / U^-Pc/ j (Ci/rv^
(LU Pwi^A CUsWp. ^iiM&Uy vyU^
k<P> dinJ^kcJl &CptCA cCO inu fycJt^
t'trC
/<^/W
f**(- P*Y> <&)■]/< W'-frC /%ju faujpkyA j|
tv- :V*le (| ^>hvtv < ~f.Ct4 J '- t l» f U V Jtr-b'e I&Y& J
nvr
ItfH'Jr ^AtOntr, f
1^-- 4 ^toic Jr?
A#- &
_ •*<> lit (jittlvv— Sfr*,
p7?>t u<J{ettuJ^ -C tftcPj} ifr-Lei*. A &p~fj'£
.•*••> c/v \.»'ic ilw, -fli ilL£Y»
jOU ' At ijuXb u JuJf
f^pSr t«H lilAAu (< It w lltupfy/l P <LtP
^iwY-O I'W tarv£ t<i l/rtpu^ i) (j-1 ftrrcl - L
\ ..ip . , j ,t-. . - r,
$M*clvvk < _ Wcicw-e a^'u. ^' V.' tu” /^u lt
|j tj i4W t ;
TrVufJhC
^uAl pr
{£v3- £p l_ c _
'Ihti
Ui ^ Kpl^ > 5 /;ar f P ^ttc L
~ \J, ^ u jibivjt t, f /vvr^ ai*-^ lvCt>
i^6-£4 - t y - yitx//fv /) i^c/if ^^jf^^4tAl/
- /uW t-4^y) {/>'&&&
rjAJtdi Ju, v^t)
' I ii£^p
h- %\ Jv-rf- "■ ^ ^
t iVlUMdy_Ay &#,tu+*y jp
(H^Ho fti^r jo^t^ - U T %fju^ UJiP. v t .t> .. /^vl)
pV\*f/ty^
•P VK*vt. c^ja<v_—■ t - F
l y ^ jtff~&lUrO |p-urtC pY Lt-f'J 'frCb-Ot
■^xk}
Iua^jU-
4-iAv^
?•
jhrwsi
*h
i*V4
^41
Xlff^ %-*? !j? s-z&
%, r /ti&z$> h ^y- +-4*/+*+* fc*- j*^*cr
/^t^~Cu«^£y ly- yd*- 1 ' t-J-'fh-it i j — __
—- 5. /c2t-n~-thi
/-J*\ -1
M /&*«/*'** „
^ lyfrn^^^^ ££ *%. & 0/ 4
Jj j jzdc&r&^J *t*
J f^d^APv y *^ fpU~* f jllt^
,J £K^? ^ £- £//t+*+y (?>i**/$t f t*
% (f'Ptr'Y t * j$**d$* jO-c^uC T>Tc* i*“
>> b^-P >fc fcf i^£&rn£& (\h&$ ——
i/$4m dkrf £4 Cpy^^€c£c 4h*s £&tsf-ut**'ft $* f >**f h)
&& C&4£l -- 'JfZprf i t ££y) t~pj ffCL y&'t'rj
fi (UtPt-fi*-£-J ^ttipfuZ* lt<?n>^ Ct l . ; i>— /hr^-'k-t+o’ (',
- / — &by': v - fa+i M fa*~ay <£& * ‘t l
r£ j &
, 7#* tf>i. Jt /Ct /u r/), w z>6& *»bPe> _ fri/s lt tL
M^c/t t V^s ^o /fo pCK-V ^ ^X tt<C^ **-f+ {fzdt+J&C*+*
%Vi) " faJ^Tj jf }y,ii. „ 'It^i^rt-J pilw £ 'h^ffjfci iSftfKt.^y
Uj ftstyC <^(-y *04A<st- C.&4 C { j Cst£pi~4 -~- fe-tt f c)
^'C'CC'4'J GsPpj fMJ) \X J jrm <-. W‘ ff^OCCj^j€cy A
4^vw rvw4^ a^i^o ^ • c^vu. . k |
tj/fysj^ *4^ 10 l^t i* ra//
hl'^ h^u dtr+±J*L^ ifattv+Lpi ^ 3 r|. / ^> / ^hM
^f^it l^d k) ^ i f ,^xxy7 rA kj4-y tt-j} ^ " C <3^WwVj
c&Lu*** id ti^-i p m*, #'j ^ ^ ^
^Il'IV >—* Aw ^ (.sA_s*r' h^VY^C*' i^\ I M^v CL<i^_ V i LL ^ / l '—^
W^- iW£v.* i^t^y i^£.4uJ -O Lt*-
J ' A / A ^ S . ^
/W>vt£
toc ^/fii^ v ^i^yv-Gi -■ ,^J
V-£»V
f^ft/-&pu*J fvLrf+r?'-' yKo a^.- 7x^\*s***-€ $l£vp^ ^ tf^A/
fl'cO^t
| AjiTH' //yt4te^£+rt**ts£' Ckte+*&^ />to J$£&s0C' frc^r**~<s
j/Q&Tj^ /A > ^f^'l*£&&%,-* — ^2. —
i 0ljp^$)r~ fjfcvt cJv *®+v L-t'<*£ C^A> <&%/
^/x ■ 1 **>**-^ Qmv^^6l£uw i$i& &i/ 4*0
£^wi«u flyx+iA^' fu \i A cbf^pi &£<*-
tvr <L^ &j\\.*-(- <fr‘i3 -^<^0 h^ Ootzjil # M
fjt,t fi f^/t, {Qj,iiM-r^&A A tfobji jxjX^ fa-^-'i' Is)
Alfa T^o. m tXreX <r>i l'Zrt is\s
I ^piM-Jvv if'] CHi^ag^t, ,U>X MM*A* •''HuvsL/-
* "Kv* ^-t-U- p *■ ^-Wwi- M U&l/Usi U£,tSihi^ jf^2 U* -v —
air |'v («/ t^“ <£'f?J'vv l Xi> ->- &v
ftnv^triwD /}Wu Q<aA (^i fiu Vi /w^j.
Wr ^VTYX'iT%aQ, i/jj G^X <itofc&X •frt'Mj—»
“ffc t -tvCt> &| .fernt. <w^ Rwr/t-s^ (/iU*y /’j D'rviJieCuj /J
C&'.lA <^r ch,v J r rtt ,, '-{Vt- iav Chavs. jfj — (h</f t-tN \X/-vn j'.d/v
I |>i'-irtrtvvx c£>U/i ^NtfTjt^ 4 ^ efciVbj
X ^Vv"-^ - /tyi4fes*£ J >v^ f '
dt-*-A ct^ct) *1 | £***■-*^ y«sc
ptf*eL ‘k^v fh^^'(>UV k&tH* &U** 'fr+vr.y r
^ A Ch ^ t i X-... 6,1 hj^A^z^ X-—
^Xf > }&CO>d)' ifc jfi&o 'fTLiA&'p^e ijC/fatb
VCVv
. * - -- v % X f v w
\yp^ iz- €^ % ^facju*^A u
V<l^t (V^licfvvfc ctwoft-f <fl I'VTf-^-t)
' l *' V ^ l f^ u!i '( iW^-C- lX^- Av4)
v - ^ i p 1 , ^ l ti ** > *'*‘ v /vn^cn
^ fit
At4l> f^t'vCiv^ ^lAMKitfcE*] ^ ykfajMs
£ t ^ i-‘ 4|'\4( tft t- V Ov^t) r : 4 -$
jv L^_ l'Mi ( - >a> QpA.y’H-t- /^ [vi-U 6^3 K^-vv-1? ^
u\tfU: ^ ** ^
:j*m
prn»sr^^
C 37 )
Causes of displacement*
1* External violence, either direct or indirect.
2. Weight of the body m falling.
3, Weight of the limb.
4* Muscular contraction. Refer to Royer’s remarks on the influence of the
different sets of muscles attached to the fragments. When the muscles are
paralysed by the blow, there is often no displacement of the fragments. Nor is
displacement invariably present, even when the muscles retain their power.
State the cause of this.
The fourth division is based upon the degree of injury done to the parts around
the fracture, and to the bone itself. Thus we have—,
ff. Simple fracture.
b. Compound or open fracture.
e. Complicated fracture.
d. Comminuted fracture.
Symptoms of fracture.— 1. Rational or physiological. 2, Sensible or phy¬
sical. First or rational signs.
a. Pain,
b. Numbness.
Loss of voluntary motion.
d. Occasional constitutional disturbance.
These symptoms are never to be relied on, as they are present in other inju¬
ries, Second, or physical signs.
a. Change iu natural form of limb,
L Unnatural mobility of *the part at the seat of fracture.
c. Change in the length of the limb,
\ d. Crepitus.
These symptoms are more to be relied on j yet it must be recollected that
change in the natural form and length of a limb are present in luxations and
sprains, and that crepitus may be occasioned by inspissatiou of the synovial
fluid—the riding of one bone upon another In certain luxations—sanguineous
tumours—the motion of tendons in their sheaths, and emphysematous collec¬
tions. It may also be absent in fracture, or very indistinct. Lis franc in such
cases proposes the employment of the stethoscope in our examination.
Diagnosis. — Fractures may be confounded with- — 1 . Luxations. 2. Bent
bones. 3. Partial fracture. 4. Sprains. State the characteristics of each.
Prognosis.— Depends on a variety of circumstances. It is modified, for
example, by—
a* The size of the bone.
h. The number of muscles attached to the fragments.
c. The seat of fracture.
d. The relation of the bone to one of the great cavities.,
e. The extent of injury to the soft parts,
/, The character of the force producing the fracture.
g. The direction of the fracture.
/i. The age of the patient,
i. The health of the patient.
/* The season of the year.
k. The extremity involved.
l. The existence of more than one fracture.
m. The degree of injury to the bone broken.
n. The existence of a luxation along with the fracture.
The process of the reparation of fractures , or the formation of callus .— Two
kinds of callus.
a. Provisional, or that which serves the purpose of uniting the fragments for
a time, and is then removed.
b. Definitive, or that which unites the fragments permanently.
There are several stages in the organization of callus which deserve attention
We have—
1. The effusion of blood and lymph.
2. Ihe absorption of serum and the coloring matter of the blood, the inspis-
sation of the lymph, and the union of the soft parts.
3. The conversion of the lymph into cartilage, which forms a distinct pin in
the cavity of the bone, and a ring around the seat of fracture.
1. Ossification of the cartilage in the spongy tissue of the bone.
5. Ossification of the cartilage between the compact portion of the fragments.
6. Ihe removal of the provisional callus, and the restoration of the cavity of
the bone.
Time required for the formation of definitive callus _Depends upon a
variety of circumstances. Usually in adults, and in large bones, from eight
to twelve months are requisite. The limb, however, is useful long before the
process is completed.
Agents concerned in the formation of callus.
1. The periosteum. Not essential, though highly important in the formation
of bone.
2. The vessels of the adjacent soft parts.
3. The bone itself.
4. The internal periosteum.
r>. The absorbents which remove provisional callus and model the bone.
Mode of union in fiat bones .
Strength of bones after the fracture is cured .— They are sometimes stronger ,
at others weaker than natural. The location of the fracture as regards the
nutritious arteries, and the activity of absorption, are the modifying agents here.
Treatment. —General indications.
1. The mode of moving patients in severe fractures from the spot at which
the injury occurred, is a matter well deserving the attention of the surgeon.
2 As there is usually displacement of the fragments, “ reduction” or setting
will be required. This may be effected by extension , counter -extension^ relaxa¬
tion of the muscles , and coaptation. We are often resisted in the accomplish¬
ment of this indication by spasm of the muscles , binding of the soft parts , and
binding of the bojies.— Mode of overcoming these difficulties explained. Value
of myodiatomy in these cases discussed.
3. To prevent a recurrence of the displacements, mechanical means must he
applied , and the part guarded against all motion. This indication is occasioned
oy the employment of rest, favorable position , bandages , compresses , cushions ,
and various apparatus or dressings.
4. As inflammatory symptoms may supervene, measures must be taken to
prevent their occurrence.
J
(OfoAs-'JLcJj’ _ 4
L-c*, ^PCZ^-d
ffo g) J^r * ^ " /iA-^4 ^ /t / V| i j r :f}'~ / --iy?
/'^^p r ^' ^>v^ c^/v A-v^> ’/ [r^\ f( ca /1 ^/ ! '14- ^
&Oyr s C* / k (Af-isYCs <l^-&U~-'i) -" L " Kj ' ^ cb-~v-C;
Cl$ l U b t- •— ^ ^ '©-6- /■ Ias%/{'\, f C. C -j S-+'-'v^}~
,/K- lst/z>^y , 3 '%£i~ J\,Zfc ty) j-.^'U
it Jdt^<LcA (/j £i^str- /yLt
fyx £t£,t*st^> £/] fyvu^&! c£tj /*U. b-Ct i -w _
t\ jQ<Xvt2~~
l^ i-'tvu'y I/CaAs-^ l^a^iaj^c cA i^L^trt) i
&ia~s*A Oy, ^
/^^aZTTbZ
r /^y^cnr &T~ /O
,_ ^)\ l/VVvv. i (/~'K-^C -<4 ’
^ - /fs0-d--i - hr\j/t*S(/y^ Isrxb C'Or
]'^y y3~fV^-4^ j^K-w-C- — U,c. (yf j £u' t-
ft^ l^ - (kW (m^M
t~ h u du. 0£-C&y£
y , *^' ^ ^ ^C^-- i u*-v(U/
Ttul p idc^- A £^yy~- c b-u^i — - cL-t***-
^ Ca ^.—! ^v-d- ^ / C-Lht<
J •* / /
Po^xA . -'T &Uyjo - fy bc~ / l£
b- O— ^iw,,^'_ /> A-^tA*^ f yp t- P'
Ov ^Aj, t'Aj^L&'l \ 'y<y |“^r A C i iX/tA^Y $&£
a -
Ai
/
■?>
Cm-
0~ t"W<
4^-W 1 . /» p A (/1 6
lx- ki-vx^, 1,1
i-t^c Ov.
|wl
cyv£
d ^ -
,rw,f _ ■ ca m
ih^^V^L
ia* y.c*eA-
*'du Cd~ <_ 1 LSjL MfJ' IvJa, \Atist*. foy^t
fl < * : V‘A ' '-***“ <3-£^y^ !j.
V *. r A 6ls*srL • ^ '•^-7
* '^Ar > ^ L / yv\*\, /*^'vw /
' /L IAavu IpCm // UWft - uAc**, [y
/ ‘\.v J f'i'/j'— AtfC/it • «L (^IrV ft S’" ft £
& rX V A* *'Y ,/pifart*J
J.
Cy1 i %. ^tu-v
c AVfV>i ^ ft) \AWj'Atyfc C*/\)L —
l^'vt / « ■» ~b « /• &■ £'' .:
. ■ • / '' ^ '-UA^t)
l v *. 7V V / V.- fft- / ^ A/ ' A; •
ftC'^ > r & f t#** «■•<'' •■ . /,'W A*
/lx O- P'y^A {-^.CjcA- 3 ist't-b* {Y%<-£'--ir.
wv A~cy~t+- fr
*~/>
-An cAyt/c /m c^ <r* r/V /<* </ak. -
J (f .-t v-7 / ^ C*-C> / • ‘ * csi^L t
J }"£* /> V lC\r^, * '’&'£■ W A S ■fojiy > , - f"
^ r>o~*A v ~cc t ' ) '-j,-
Ci.i\sL tw/urp-'f Sftp ** «y v f O'y/sr-y^
P/iu ‘ A *■■*6' ?■ yzy /^vty
i.4Ct\,u) O-y cAcC Ci t ^ ,
£s(/Ii«*c *. ^ / .// i %),
\ ^ L^Otr^A ' Vt ftftftA-
[stt ** W^ : *^i fcrA- -- ,1 ' <^
A i'vA «■
0
L '
n _
'r<> '~Uyt.e l "1' 4-&U' X
L. y C
’ ./ :r d
ivr
y
<1
fe ^ T*
j ^ Ct-\~ &(, _ 7u,-l4-tj~ j
„ &£ - /i-> / /" ■ ’^'t'’ y ((Z^L &<^~ sd^x^c $1^
Av ^Ct-v-frv G^hxCiS S>>s y. / c\:’ck.-'<- C{y
CUh uC f l r 1\> Jh&L, 1. w }&-€. 'L-* —- 4^
^r4^<n^d. dCre-fi— y, ^^r-t
/7^ £>r-td° — £■'/?& , fl-Lsr-Cst* (L+t,
/?VL^vv ^x/ ~i|
^ w ^ ^
dfttjf'J *- £ t Lh~ ) Si L w/) ^P mm t*0C'/ v' /^
^/^rnv t ^ * /r -<Ai^^e ?>l^cdcCt4j &sf >/'>■■■<•
farfrAV istp £tOlS~C\- ^vK.^n^ti'. /
l y C £^v~ Lsfc) d't'Xi'+JS ^~)+ \~4>lr-C' IVv*^ *
£ •*- S z'CA-'Cft. £ y } ^b^Vuym ^/O ( \ * ^-.»
V/^'l /y^wvv ( tt tCl ^»w■ 1^4, / j
y^, fr**-f ^v4^w ^Lfrt cTT^ S 1 < *■ t)
- *i /r}'~^t-- /Tv-r- ^ [ { t l '■jt '
z_ v _ fryic+^~j £ u^JLa* c*-$4w c^cl
^ /W fvfcZZ >~, ,- /:v m * // 6. j,c
.^T —y
A \ /^v o y £‘i^L ^-—A -^y~t- / ‘ r '''\ v '
L r ij/ &y<?y<~c~ J-tj/p /i. dC ,'t t ^ t t^ l £ l ^
t^v ^ ' £ v£t-sj, ^ /t- ;. A Y C&S j ^/ 1 1
ft-ey y^-/ufi- y^ >t »'- !> -<
* , _ j | |
v /"?-> •• • */ 4 » <t- iWAL /’ 1 1
/* £\. >■£* A' tr Ck 4 C+-> 'S'tl'f /- £ t> if I'
Ci^ V i4tJvv* y t-vvi-Cw b(.uA(‘'~
* A'fyvwO'^ v f—U^ Iaj
»
.*^ r
vy. (,/7-tjStw^ (j^ ia- 2< o
J ,
/£ - J~7y He
M* V/V H H
/ 1 *y $-&r? r Z / —
C(^v*v^p f / *Vv^V w -
’ ^-/h t ^>~i-iU-'d\£ hp^i^
/&/-AtZ£ tf £ty < „
d, *W 4 '*- A*t-^ />!• ! £*Y(• - V d' <51 /-^ t v
LL*<t ( ft ij
3 > t Ce\ J~t. h i c f ^ Xhi/'Jei' Xye C^/C f
Awv t. cht t *> C c-^C
Jy, ?l*s6 fcj d^c^tfeT
£ t n, /i*tf y l )i.
iv i Oi W^^Cit ^ k Ct-iA*
j$> & i, f A’- \A^^ 0 ' J~<
-J / la ut [w^yld fY t{Aw^. : C -t ' ' ^ ' '
^0-W ^ \A if '-
Ce^ 'u-^e . »^y ^
/ 2^/0 %£*a^ (Ledr $jA i^Ui *4^
fa>)Ua/%z~., iyj£ ety A } ,Jf
/c*^ C . J ■ -A /iy
^ A <• V f/ ^fcc^wi--
t7 #fr- ( ■* - :. ; : k-A-
(Av^V- [**'-* ' - {^W ■■ it f "' -./ /, ■ -1 k |/At
■ vx h yv>o Wtvw (yv^vt^v- -
'vrv fj
1 &*U Ufa
Vl{~^~ PYtT^VU-^ *£y U-vv
_ » M^vO ^pAW^' A H
U?vA- t CULt t\ -WI \v t v- i v, i ' k
K ^ vv^cAa /WV a tv^ ^ . u '
IU W
^ A* ,sr*is ot/kjU 4 k%~ l/yyus C
/W^vy ££yhr-> jw^^T (rC4***~-
/C~ ( ^t t v y z£~ ts'J-—-—. i?3us<^,
//f'h t't' i^ s /fi s ^*, 1 *•*• '7*~ ty j
*'y /} p( /sf ffiie*. *-l-&*ics t
^ ityfcriC- tf- £i-
l 0. . /h-c^ AtiM ^ n~ At
<U^tCZT r ^ ‘'
/£Pt- J 4^ p^x,
' ,£* -.
'$b\, <J> £ r *‘-'-J~-C-*i£/*-' ^Y~t*-4*s'i' JlAsP\S>- /l tv C~ ’
/%%#*•■£■' - g<At,'lts4' /Lsplt4r\\C jHiL-(,
^ f £*f? JoLMsf*
tiuj /■■ &l-’tfl*mr /} A--{ (lk“, i .' I :■
A, Jwv. &V jA&^jO^tXy
'feKsA<U* /hrPiS fUtSC _
£^-"t-' /p A*~^- A"t*~**P » ^ f‘ c4^f(.^ t >
$■%/>*€> fib** f C< ^' ■ Cr
^npp^c4 £#t,yh — ^2 v, f.> ? /ty. f
,iv? ^u^~ f/ y l ^.yj /-z-
ft^ud 04-A, yfcTJj-0(£^ iu-CtZo ffi. ^ fhu^,Q^u^ ~
"fa )— ^4^ ^7 $*#■-* p£* ~*- * j) Qsfx&c. $^£4
~fy ££■«-■-* . r JLsfj s. Arf 7?r //■' *4r ^feSSZ
C*
/^*f7 fhth'f(4#-€ /jv^t <
14, A< jP^lfA Itdi frtA'
f ^ tec &*, /)i d-uL*$' i^r y,
^r- 4^^^^ y^y /X *^4y ,
prfY~- &r*W4 Vy i^-^t-t/K — ' -/
, pj*r H smU> -du^ £*4 c*o
^ *0 **&*& e**j^c£c. /Tv^.iL tr£rt
rjl^ *»h-'J Aufi *)■ ~ /Or /| ( h*-tc^ Jts-tSfa:
c- h*P V11 /u£** lAM^hc^ /^ hQ-^ PtCZZ
/ Ux-jtXt^ Qofnl+d C /t^Wc (t^4/ui4 A /yP“
fcf *" 4n />- tos-isCo /i&t
^ - y - - *- ■ /1 - * /jS
&4sL* f ^+^i j flf }n4+&h A **-/
Z 1 f faL^Ct&i) /irVv^ [j
/v* 4ir+v/v(^/ 4uv
7¥ut+± w /^/ - <^Jo/c /fa ^**/-: it:/ AC^/X
<ovit. hfi.^ ~fa+t M- />, <*u-A. Mr*~~
6^/c ~M/i ffo-B'-jP £■<- £trfO (td*4'‘t i -&' / t yefczx,
r /n.^ j f S 7 *r(f 0 <-r
P^' • • ••-« ?>-i £ : X - /£- fy&tsfa' fH, Cfrto-'/rvZ)
p '*-6 ,’-\st-t. 7 / 1 & t -~-$-£4 -
/As>/ fX^l fy> u^ja rt-kj\
~fl A* 4,/j vy Uxi\ i , tsfcOj ^ ^ {4
^ — /#vwwn ’v^tr/kCt' 1^ fir^’t {fsi-j v.: /vwj
/t” r ■'jS-Pt-v ; ts/er p C-
OL#£iu~0«£Oi> Ut^cJTi j] & ^-y, 4u&*i-{bO U'lZ)
flX. &/,{,$£ U/l-c^i) ~h SivjA-i t L*'-/-4, • r, + t,ts-$st>^£'C
I llv^Jh- ~ -Mr^-L apwO JUpitoOZo f'h.firU? A-iW^Kj
M t^LCr (D 0*yyt kfr\t J h-^u d/riAji
I t^liy fi^ Qc’ (jutCt, •IfcWN-C /> I'/y/tOC
| l^w«wf4 aofvj^o- /teh*. Pvt. &sfs£\ Hsi? /toik
A*- ti/e^U/Z freuStr-^yt. Ut%»S ^,ph ^ fXZ
y**s6jk, *£*£} u*-t /‘i Qt/itZZ £%**-t) 'pn. / /^- v b-An+ir^
■ ~0ZZ. Cprw yv ^3 Ito'] (X^MVl fts f)")L
I C L ZpZb Qv^iZOb iM. /I ^-a^ZCi^n
tXr. ii fd-t'C'^-^j F'sfrTUvc*&4y*> OOtZ/i'.^ ^yj) *J
I fc^(> J?T^ Z 4
CMA' (\*v*'V , >' ^Vv-iJ} i y ; V \7^
' ' ' j^:'.wJ A tfti. j W . y ViTvA
4
‘D
( 39 )
5, Spasm and pain often occur after dressing, and Ihese symptoms must be
relieved by anodynes, cold or warm irrigation sometimes by changing the dress¬
ings, and occasionally by bloodletting* Be careful, however, not to deplete too
much, as callus will not be formed unless a certain degree of excitement is al¬
lowed to take place in the seat of fracture.
fi. In applying the dressings be careful to protect parts liable to pressure, or
that seem chafed or swollen, by straps, cushions , and proper position.
7* Carefully inspect the dressings daily, but do not disturb them so long as
they are steady and properly adjusted*
8. When phlyctame form, carefully puncture them with a needle, but do not
allow the cuticle to be removed*
Should superficial or deep-seated suppuration ensue* it must be treated on
principles already laid down*
10. During convalescence the patient requires strict attention in order to pre¬
vent the occurrence of “ secondary fracture. 13
1L After callus is formed, the parts, especially the joints, remain rigid.
The indication here is to relax this rigidity by friction , passive mot urn, warm
douche, vapour hath, electricity and galvanism*
IS. Finally, set ike fracture as soon as possible. Do not wait, as some ad¬
vise, until swelling and inflammation have occurred and subsided.
General methods of treatment:
j. That in which the limb is kept extended in the horizontal position,
2. That in which it is maintained in the semifixed position.
3. That in which it is encased in some unyielding and permanent dressing,
as the « starch bandage, ,J or plaster mould* This dressing is sometimes called
the i( immovable apparatus,f
1. That in which the limb is suspended. This method Is technic ally called
- hyponartheda. 33 It originated with Sauter and Mayor.
That in which the dressing is composed of handkerchiefs, variously folded.
■ his method, from having been introduced by Mayor, is called “ Mayor’s hand¬
kerchief system. 31
6. That in which the ordinary splints and bandages are employed.
Review of these different methods.
COMPOUND FRACTURES*
Definition*
Causes _1. The fragments of bone may be driven through the skin.
2. The integuments may be wounded by the body causing the fracture.
3. Sloughing may open the integuments*
4* An abscess may form and open*
5. Finally, pressure upon some projecting point may cause its ulceration*
Dangers. —-1* Immediate shock to the system, from injury to the nerves, or
from loss of blood.
2* Inflammation and fever*
3. Hectic fever.
4* Tetanus*
Question of amputation.—iW hen called to a case of compound fracture, we
are first to determine between the propriety of amputation, and an attempt to
save the limb. No fixed rules in regard to this operation can be laid down,
but we must take into consideration several points.
( 40 )
h The age of the patient.
£ His constitution,
3 His habits.
4 + His position in society/
3 His means of obtainin'' proper nursing, food, &c., during the treatment, if
we attempt to save the leg.
0. The season of the year.
7 A t mofphe r ic pe cul i ar it \ e s,
Circumstances &rtppo$m jto warrant amputation,
1. When the injury done to the soft parts and bones is such as to 1 warrants
the impression that gangrene will inevitably ensue. ‘ ' •-
3. Where, along with the fracture, a portion of the limb is torn off, as we
see in wounds inflicted by machinery, camion $hot ? &c*
3'. Where the soft parts are extensively stripped off.
4- Where the fracture extends into a larger joint.
5. Where the bone is broken in several places, and the soft parts Extensively
injured,
Q. Where the fracture Is complicated with laceration of large bloodvessels
and nerves.
Before resorting to amputation, oven under these circumstances, weigh well;
its dangers.
i Time at which amputation should he performed .—Difference of opinion among,
^urgeons on this point; some preferring immediate, others secondavjj amputation,
ft would appear from, the reports that in civil practice the latter method‘has
been most successful, while in military, the former is most to be relied on,
?vfany cases, however, admit of no delay, even in civil practice, and the sdr -
geon must let experience determine the course to be pursued. Never operate
until reaction to a certain degree has taken place.
Treatment where it is determined to attempt the cure of the injury without
(imputation,.
1, Whm the injury of the soft parts is comparatively slight . Here we m ust
dose the wound at once by straps, the bandage, lint soaked in blood, or lint
covered with oil-silk ; apply splints, or the proper dressings, and treat the case
like one of simple fracture.
2. When ike injury of the soft parts is more extensive , and the hones pro *
trmle and overlap, and can?tot readily he reduced. Here divide the soft parts,
pick away any loose pieces of bone, and, if necessary> saw off the ends of the
bone. Then apply a loose bandage of strips, place the limb on a pillow in a
fracture box, or upon a carved splint, and use irrigation with cokf water if the
weather is warm ; or, if the accident occur in winter, we may use the warm
water dressing or a poultice. It is m this form, also, that the bran dressing of
Dr. J. R. Barton is so useful* Constitutional symptoms are to be prescribed
for*
3* When, in spite of all our efforts to prevent it, profuse suppuration takes '
place, we must give free vent to the pus, and support the constitution.
■ L After the subsidence of swelling, suppuration and severe pain, treat the
case like a simple fracture, with splints and bandages.
5. Where our remedies fail to relieve, and mortification sets in, we must
amputate if possible.
Z CcKisnZ&A.. SStf
- &2u A &U<£& &fvu
^* Wt ' '/S« ■* £h>*4*p ^a^i> X ^ it-*#*'!?
n*# ttf' JuZsUstp, /fasts^O t£c>
jAu^(Uc 2$%su^-c t <f 4& £%%*>{ j /iSk,u£^ti t r^
J-0914.A *■■ M<y &/ ^-/*.tt%&ZZ£)£&nsC*f < ''Cuts*'*
f//r ^ ' :> C2**.<5 M<* :4Zt *-/' $4
f % 4 * /a»*Av 4/ Mn 7 T*i,i*£ .
Jk*$t £'*'&’-£ **• 'gj^t J^v^i^£ ^ r £tt4/i4,f l- £-C —
^ -/^/ sU$%J^e3*- jS^£> '■^j,r''
cC<4s(M. t f— Ijjf h&-&t‘ j^t&t^- z£tfo--i- <f
<C, c -btsmaC^ i&j facs //t-^cj &**»***&
W ^ -J
L " s Arty*) &4H+** &*+*/ - 4t$tt
J • ifjjh&tt i- £*- f**+*y~lk; ptAJPm
(«S> t$t€+ '%F dt'-C/^-f JtOSpins t 09 ($jfcu*£:
fjffis', 7 ^ ^ &pu*p£& — M&&/*-* tjf
<^^4 4 «i trf jK‘t*\j\/.*J
& jiut&^issjc’ c^zA+tH- J tc^K &&+%■■ JudA-
p$> tfCut&**•£' /■<# u^- f-<? f ^ r ' //-i *-■£ jKJ
j )d /iSt-sO- ££*+% /?44.' ^j(t,
& &£*&**#■ _ y^y 0-ir {t * h. y £.&' <</( t
A^SAt/M ^-it #■ ***f#,s/
&/^ Aiiu t^ c fr&y * J?
I'-t
C0L y&£ * *JL Cb~ ft f y ■
JS*"- v- ^ ^ < f , v r / V ^// / / j
$#Q* alines 2£*ut
^gylxZ tf)v Iva^V - u
/4 £v
31
JV■* Q\Im(sv , 'd~ J N *tzL t- V*4 r /*> > 4’4v^ l^'s~~-
CfKwCh*. jflA> Ol^L^' lO
by ^Kvt*^ ’i) ^ ^ £-4s4yC'
:^4JU J^ww ([ 44U- /;.,
,£0^ IV ^ 6t*i^ tr^ 4^-
^ ^tvt>4 <u*s'~(/' £LlC Ctf-i u>/fcr~~
t^’/u'.v gc* K*v£ * fi&fi U^P^yJl —
► 7^vl> / ^ C^Vvw <£*4 *
13 « /* Kx<AWWa^Ua 4 v^w c/*it«tjd
;-: v)v i»/M mv
I *■ rfsttW&U4 m J lLUyj^0j{£^ i*4
I VVv^. C X #= * ViY J (\Jt)Al " tAw'|W/p-
£y£4^ (hv^P (xr.'V\*L(&c* w m / ^
'I) g£kyf AdJ $AV() X •*&*'*
(fW (K t (Jr- i/I
(h^fwiCw id •
. X-dvvj *j ^O <J-tA»yt^fvw<... 11 $ (
/VWlJpfcrg, ;\4 WtHbfy. /l» tlvv. (36 *
{^Wv, v -M^£- '^j «
i/woc C(AVvjp Wc^/jW bf UlCAv
dfA r try*, A-kg^G try 6 Uv^t j ift Irfy^l,
I I Cvr C*cv*-ijjfri:iv+s JUfoW tfo Ulc*is f 1 ^
+*Hvv3 ' ; $ 6^4 VKt- QJt.Z-i?3'J Qy^s If-1 Cllti Ci-4^ j
\ (j lAi uit* <S>Vvt) "tUtW (3/i'^' / ^ A/»tC 2^
fif| G#Vt to b&.&jr y
/pjhfa- ytsrf ► / - " {yjw&its ■■ /v <rU4 ^v/
/^h'l 1 a- vvv (. if H,v-V^- V -t f„ /"J? 4 'P'KjC' /-y*
ML.— faxCHy J^o i^J Gc'wVp *j&*v
v |) V u-<' n'frv*- Gv v^ bsCfovu
t,'/
****** fiT jCt.y yks
ftc* Kfc •>» (fjj. "pkij aS, A^tr t i. st
Vfc; ft : C J _2 Orv V
pUtJr u*> ' iiMl^
'tUt-' } {/Y\s t > ? ,"' '■ ' *v jpc f £/ — )
l**A> Ovvvv^r '^rj- iJa *fy\- v (M*
! /vV t/j) £VhTV^ ci'tfV—t/^ ^n,'
I fa™'ft f* 'Vu & _
^ ^ **y dfi&c
t '2 ir€ V^. u)tosd&J~ „_ / *^L
(UL @4Tp-t'*“ i/^c/Ci~c^i j/\'i ~£* r '' —*"
£K >^/vv , k^#c{ ?UW
p?i^ ^yf ^"tr '- ■■
•v. | (Irvt-w'U^ IvWfV*'
TaUVUK t&fa j/$k^
Jt> u \*y .fctosfy,
tev fa C^^jp
i (ri^S C&V v4> p ^ *- n? £ r |>>Uv
^Tw\ t w*jO * j' | v^W* ^ / £ £ : V ■ j-" ^pi
Ai^-i" y^ v *1,—> V^^w©uvv^/i^ ■ /
^vvoto-J V^Jvc Vviw^i (^'Vj£/
|t^v* GStfwv b fo £t ^
'tMl* &^tfV h) ^vt (tv» I* / •»•
£**¥'-hf <fa ^, a f^r -,
Wjl&wt-t** h y lcO^U ) ( v f vt.*v. •
W.4i jts ^ trV CmJ fc 6
a itrcx/ J\cm 2 g*‘w -& £h v w Cfv^» ,
V'A.^V^V i/lvUv^ i-VV it^Vlr 1 -'
J^t-*"^ • .jj^i^-C tyfcl'J » /'^t /
&\v6E a#TK^ L - U"U,
r fa .^^.Oci^P ^
5 —- fi^vvtH^ V {^v-w'^j
I h ’-' t^^v\' v Lwb
I |5vi^ {Tbw tf |0 ^wVl" -
t^vVt^, S UTK^ -
f &m4!> /', v -#^6 ^ ^2^^€^i^ : -
$7^4 , A-**- <£^- <^/ /)£- 2^.
&~tp£ '£t—*£t*u <^Vt- / ‘y^fvX •/•
<^ w '*'" ^-'v^v &~% r -'C'+-4^ *-eJ^,~ rf^i»- ^
&Jrz, pxf&rzs
,. o
^ ) y W . ^4S$ /idleZl t^ . A&Urjk
rr „ . CCfr*\?4- .<£«. / ^Cr irpt
/+it Gb\&44i*-p£ iuLcs /^ vc3
i^y»^ £p&*4t) £>■*„,■£<.. far/Lti** Jt-et#-4*
&+& M# d%H-- } j$ Atii. t& * (Ztt***
*> As~~ d-u^MUr , /§&. , / _
X**-^ 6f*~**~ *!'« ■•( ^-et,. e?rAj
<~, «4^> /
<is - ^ ^ - - D .jft^/^K.^ (<^4
l^o-.‘
C^-'u.-Vf-
(\jU-V-^ tfrs*£- * H |5w^w
* u V AV ^ ^ *2- C& 4^ '^ k^
' tyl <v «) tv #~&i /Jk. fvfi^ '* »«■' ' f ,
*'*,"• rrVWsd/ C v • v t^- &i-v- v ^ < v
^w /fnrv a WuJ^^
K^Vu) dG~£<S */UvtA f t*~y Of*1 Ct M-£A.s_ £'£C£.
I *r I'Tmial ._ 1*X J
6*? V ^ 1 - ~
(&?%■* ** L'M~! d i ±'&' i ^£'CJ
Qju\a*S$~s —— \*J<X L (j (r'irtc^^f t
(hx&r f uU, & oJZvw §tiM
&jj l/w w*t ,1
/
4 ^ ■ ' cC
_ _ - . . * ,
Pv (3- cd'O
i'-'j
PctAStA, C
'^ t\vu.7wu/ Jx-L^vl tt^rvUM
rt^L^U^t
fZohif. fowl^
Ha _ )>v/^ {y iAv^/vv^/ t^-t HcLlmA
QT'tb- & C4i v i ; uv U ' t- l'k ^ fdr Cu^.
"filtm, t- Vwvdtxj yk^c },/t > // . /v /r ,v C
t j LuwO /u CLi^i (a C^^CS-trvU'.a^ i'rl-fu.
tt ! bf xflflX'- tfcCT ffijojtfv J > { AJLbl i £ h/\A^
Hv PpiXcL
^ £mA» P y ihb
4~l hL, p/£s*<- i^h l' 1 * w ^ £t < *--
y7<<f^ A/tm^ htsilZL — -j-
b* c n\ i^Lctt^ trtf^s h f
i [tn^cJ^ ,h v ^— b i\ „C-C ; ^ /- (sr*~PS^
V*-'- (prr-^L. 0 {''*£( <■■ l l+ x
J / ^ /t -4 m I I V> > V,/, <— r /w
iJ^L L^Ctx'/t X^vwt
3 73.^ f&t (Uo«& *vm
7 i\ ' I i / )ViA^iyAi'
$> (Tvjy^-v-}^, /^-v^ /v^sf duAjx^ c , £w -
fetu 4~. trw«S()
Qr\\ ( : cl^~J> tvmr 'Vu^ p ia-c
/ fUp i^tl ip 1 v 4 ?< 1 a &*y-
; f ^U. j p.- y'U «- G-c(U*~ C-t'i i t.
(Kt, Ci£u t **.@dUv&-y0 ^v w 6'^? Ct- C trTS
/tt^')| (1 C^^.i i v'.wi5X |/r% Cl/w- y c (4<J
Lw /t* , , , ( -
5-'^ji./ )£/ ? AcG>j tij P v
(a' 4'\A< PVCvU Ax ^O^x/V ■ ^v|^v/-'C ^ vi-'t vV
Ofc^lpV v ;rKX ^L u^c
Vyt\f j j^’.^ Vo
( 41
Character of the callus m com-pound fracture and the agents employed m its
formation .
COMPLICATED FRACTURE.
Definition.
Causes .—The fragments may be thrust through large vessels* or nerves, or
into joints; or the force producing the fracture may cause their injury, or
occasion luxation.
Dangers. —1, Immediate shock to the system from loss of blood, or injury
of the nerves. 2. Sloughing from infiltration of blood and serum. 3* Mortifi¬
cation from loss of nervous influence. 4. Permanent paralysis of the limb.
5. Phlebitis, 6. Hectic fever, 7. Tetanus.
Question of amputation, —No general rules can be laid down, but the circum¬
stances already stated as modifying our treatment of compound fracture, should
always he taken into consideration here.
Treatment _Varies with the complication.
1. Where we have profuse hemorrhage from a wounded vein. Bleed, apply
cold, and pressure, and afterwards frictions and pressure, to cause the absorption
of the blood; occasionally a ligature will he required. Be careful to prevent
phlebitis.
2. When we have hemorrhage from a large artery, characterized, where there
is no external wound, by a tumour pulsating at first, apply a ligature above the
tumour, and do not as a general rule open the integuments and seek for the
artery as advised by Boyer. When the collection of blood is so great as to
threaten sloughing, then open the tumour, evacuate the blood and tie the vessels.
When a wound in the integument exists, we may sometimes dilate it, and thus
tie the artery above and below,
3. When a large nerve is torn across, which is manifested by paralysis, numb¬
ness, pain and spasm of the limb, we must bleed, place the part at rest, apply
leeches, cold or hot applications, and give anodynes.
4. In comminuted fracture, complicated with a wound in the integuments.
We must take away splinters, provided they are not attached to the soft parts.
Close the wound and treat it like a bad compound fracture. V 7 hen the bone is
crushed to pieces, it will generally be proper to amputate.
5. When a luxation complicates the fracture, always protect the fracture by
some firm dressings, then reduce the luxation as speedily as possible, and after¬
wards set the fracture and treat it according to the rules laid down.
6. When the fracture extends into a joint, we have to fear intense inflamma¬
tion, arid must treat the case accordingly.
7. When mortification takes place amputate.
8. When tetanus supervenes treat it in the usual manner.
IRREGULAR CALLUS, OR FRACTURE UNITING WITH DEFORMITY*
Causes, —Usually, neglect or bad treatment of the case, or the wilfulness of
the patient, are the immediate causes of deformity.
/ Question of the propriety of interference in these cases*— Many points must
be considered before the operation is undertaken.
1. The duration of the injury.
2. The degree of functional injury resulting from the deformity.
( 42 )
3 The practicability of relieving the deformity without endangering the life
of the patient
4. The size and location of the injury.
5. The age of the patient.
G. The health of the patient.
7, The season of the year.
8. The existence or not of disease of the soft parts or of the hone itself.
Mea?is employed to remove the deformity .—These vary with the duration of
the injury.
I. Pressure and extension of the When called to a badly set fracture,
within the first sixty days after its occurrence, or while the callus is yet yield¬
ing, we may often succeed in restoring the limb by well regulated pressure and
extension of the limb. Cases are reported by Bnpuytren and others, in which
these measures have succeeded even after the lapse of the 120th day from the
receipt of the injury.
s&ton —these cases Wienhold proposes the introduction of a seton ,
which by causing suppuration would break down the callus.
j. Rupture of the callus.—If more than sixty or seventy days have elapsed
before we are called 5 as a general rule rupture of the callus will prove more
useful than any attempts to mould it into proper shape. This is an old operation,
and has been recently revived by CEsterlen, Richerund, Dupuytren and others.'
/ Oases to which it is applicable.
Rangers of tk is operatio n.
$ Preparation of the patient .
U Mode of rupturing the callus.
J- After treatment ,
/ 1- Resection of Bone ,—*In cases of long standing, where the bones overlap, and
aie irmly bound to each other, pressure, the seton, and refracture, Will all fail
to a fiord relief, and we must then resort to “ resection of the bones P
Dangers of this operation.
Preparation of the patient ♦
Mode of performing the operation.
After treatment.
r>. Removal of exuberant callus .—When spicul* or ledges of bone are thrown
out around the seat of fracture, and interfere with the motion of its parts, or
occasion pain, we may, after waiting a few months for the efforts of nature, cut
down upon them and remove them with the knife or saw* (See cases of this
deformity reported by Alcoek, Velpeau, Dawson, and myself)
PSEUD ARTHROSIS, FALSE *JOI3fT, OR FON-UXlOtt.
Definition.
Frequency of the defect.
Varieties. —l. Where the fragments are united by soft callus. 2. Where the
fragments are united by a ligamentous band or bands. 3. W r here the fragments
are united by cellular tissue alone. 4. Where a sort of joint is established.
The bones being rounded off, tipped wdth cartilage, covered by a synovial mem¬
brane, and held together by a capsular ligament. Very rare
Causes. —X, Constitutional. 2. Local.
C 43 )
First, or constitutional,
a. Syphilis*
h. Pregnancy and suckling,
c . Pevers of different binds*
d. Cancer.
e. Fragilitas ossitjfn.
f. Scurvy.
General impoverishment of the system.
h. Paralysis*
*■ Deficient supply of arterial blood.
j, Advanced age*
Second y or local*
а. Frequent motion of the fragments* i
h, Separation of the fragments.
c. Disease of the fragments*
d. Interposition of foreign bodies between the fragments.
e. Tight bandaging*
' /* The long continued use of cooling applications*
£• The too early use of a fractured limb.
h. Division or stripping off of the periosteum*
i. Want of cellular tissuo.
Symptoms.
Diagnosis.
P rogue sis.
Object of treatment.
Treatment. —-Various methods have been introduced*
I- Simply beeping the parts in splints for several months.
2. Friction.
3* Compression* *
4. The application of caustic alkali to the integuments over the seat of fracture.
5. The introduction of a heated canola between the bones. Proposed by Mayor*
б, The seton—proposed hy Di< P by sick* Modification of this agent by Rhynd.
7. Escharotics applied to the ends of the bones,
8. Removal of the extremities of the fragments*
9. Section of ligamentous union.
10. Section of muscles attached to the fragments, coaptation, and friction or
pressure* Proposed by Dieffenbach, in false joint of the olecranon, patella,&c*
11* Acupuncture.
12* Electricity*
13. Blisters*
14* The use of iodine or mercury.
15* The metallic ligature of Somme*
16. The actual cautery. Employed by Kirkbride and others.
17* The introduction of Ivory pegs.^—(Dieffenbach.)
DIASTASIS OR SEPARATION OF EPIPHYSES*
Definition,
Age at which the accident occurs,— Varies in different individuals. May
take place at any age previous to that at which the epiphyses become attached
by bone. This generally occurs before puberty*
( 44 )
Causes .—-Violence or muscular contraction.
Symptoms. —Obscure. Unnatural mobility at the seat of the epiphysis is
the most important sign.
Diagnosis.— ay be confounded with fracture or luxation.
Prognosis.—The injury, if properly managed, rarely results in deformity;
if neglected, the person is almost sure to be crippled*
Treatment —Depends of course on the seat of the lesion. The general indi¬
cations are nearly the same with those laid down for our guidance in the treat*
ment of fracture*
4
PARTICULAR FRACTURES.
I. NASAL BONES.
Liability.
Causes.
Varieties.
Complications .. — ►Concussion of brain ; emphysema; injury of lachrymal
duct and canal; fracture of cribriform plate; inflammation, and caries or
necrosis of the bone.
Symptoms.
Diagnosis .
Prognosis *
Treatment.
M
Ar
5
/?
II. MALAR BONES.
4
J
Liability .* — -This accident is very rare.
Causes.
Varieties*
Complication $ *
Sy mptoms *
Diagnosis.
Prognosis.
Treatment.
Ill* SUPERIOR MAXILLARY RONES*
Liability *
Causes.
Varieties.
Complications
Diagnosis*
Prognosis*
Symptoms*
Treatment*
( 45 )
IV. INFERIOR MAXILLARY.
Liability.
Causes.
Parts most liable to fracture.
Varieties.
Complications.
Symptoms of each of the fractures of this bone.
Diagnosis.
Prognosis.
Treatment — Depends on the seat of fracture.
^ V. OS HYOIDES.
Liability.
Causes.
Varieties,
Complications.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
* VI. THYROID CARTILAGE.
Liability.
Causes.
Varieties. *
Complications.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Liability.
Causes.
Varieties.
Complications.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
VII. STERNUM
VIII. RIBS.
Liability. *
Ribs most frequently broken.
Parts of the bone most liable to fracture.
Causes. — External violence. Muscular contraction, as in coughing.
Varieties.
( 46 )
Com^l{cation s,Heccoptys i $ : emphysema, pi emit is, empyema.
Symptoms,
Diagnosis.
Progmsis.
Treatment.
IX. CLAVICLE*
C*l+- Liability .—Its shape s teaatore, eo
this bone liable to fracture. /H-
£•— Parts usually broken.
Causes. —Direct or indirect violence.
Varieties. —Complete, incomplete, simple, &c, &
Complications -Paralysis of arm, injury gf axillary plexus and vessels.
(Earle.)
Symptoms.
Diagnosis,
Prognosis.
Treatment.— Various dressings employed to carry out! he three indications
of Desault* L Desault's bandage* 2. Boyer's bandage. 3. Mayor's band-
kerchiefs. 4 Fox’s Apparatus. 5* Brown's bandage. 6, Dr. Reynell Coates’
bandage. 7: Hiester’s dressing. 8. Sir A. Cooper's*
X
X. SCAPULA.
Liability —Its site and mobility protect it in a great measure from frac-
tore. |
Parts most liable to fracture ~^l w Acromion process. 2* Inferior angle.
3. Body of the bone, 4* The coracoid process* 0. The spine. 6* The
neck*
Causes ,
Varieties.
Complications.
Sympt oms —Depe nd on part broken *
Diagnosis —Depends on part broken*
Prognosis. —Depends on part broken.
Treatment. —Varies with the seat of injury.
XL HUMERUS*
Liability. —According to Longsdale, fractures of this bone are propor¬
tionately less frequent than Is usually supposed—about one-sixteenth of all
fractures*
Ages at which it usually Cbildhood and old age.
Parts of the bone liable to fracture. — X. The head. 2. The anatomical
neck, 3. The surgical neck* 4* The epiphysis. 5. The shaft. 6. The
condyles.
Causes —Muscular contraction, direct and indirect violence.
Varieties.
1
(fwrts CiSfczu* flO&x,C / / y l i r ts-fil
fr f^T ' f*^L Mfcgy fthrSft-* ' J\£a///JA
- M^tZ ~ ^ (h^cUlu&jLp^^
USL^r: , V e f^ t ' <CU>
A'*'*- Z/ ftftkJ^/Ust^S] C^iy-C*^ /TrO-t^^Cs spK^sv-C . _■; ‘Ay
M6tZ~ Jl fa t £J~C-^ ‘
O^^aA- vt-<^t t£ *4 <UA*t 6 *~
£ko4 - ^ ^ ^4/ *4*»*?J t- '' ^
P^ ~ jfo* ? ■'■ ' - - *., ~y /
j<T fdsrnuffiiUJ ps+ts ,-Cy^; 4^4 ■
~f£ZZ7 tA~j ftU'iAy £9%*&*<' *r
ft o£~ - U&m? cu^dft> <rr c££p "> ••' ■ *-
—*. ^
'Jf—t'fp l ft 3 ^ Si*jJ ^
£*L$r £U?^v/’ I
x^<U- /L>c*y — /t*-? Ar&*t 'ftt- t***- 1 ' .:
4 (W* 1 / ^ jdM^tto c <5t4 /7»V.«.
U\ ^ J Ilf t-CC' ^
O/^tp^- t-*. *> ^ - J. *V vvW
o^yf^ftJ^el _. / M-ftS*' v'<^ ^ /ft'j'^Mt
^V / ,• A/ A ^SM^a A*»- /<£ z'X
^■V^t ^H'/ivW £V ‘z X-f'Ufr ,
y^j ! t^t~4 r fan. • y /A\ tr ft . }[ / i* I A t H"i. t-
? /6- l l'i'^**- d l^fWV /^ ^(/v 4'^
) 6 >U Z-t A 7 '*•«“ •' 1
i^w<\0- llv* m-v/«f( Ci-pjy^
£:< 7 /r^ ft - 4^*y A^Uw (*-f <txA ! -I
jt.ft-^t-'c'i fitted <vhvA-£ / t/y fkb4 Oft>Lo
UH£^ G*.(tu 4u ’P&4 M ~ pfi£t «U*/" -t' j
f?^L fCiiflv f~ CX-^-ij) £t <-( r ‘C t * L^- *-"
Li ? G^y*r «*-
ft'Hf-j'yv gytvJ ^ f'f^ ^ v'( r Cw*^ jr
JifijA' C*S"j U^AV»^~ (Wu^ tatwM.'U ^ I -
Bja^rtv^l ;.v iK ^«/Vnv^ U fA- # c *^* y ^Yv^wC \» V
I
A*Wvf« &£i fa
tspQlfa.* {X 0\Jti/0 C*~CStfl&r« D r faUt.
Oev.<Uk F&tv &*« W€*y .
mM >*&*£ t^ft, J (kJfa- 'utftr^f
'W-lVtfl
S ‘ v ifc itXu^v ?
£lwt)
^ dA'fai fti/p kcfa
hVts £*^fa)
'
I , >/, 4JUaJ
t *+\i
: **££■£,
.'M-' * Wt'tW''* —
5 «r ch'>\'\* U(/Lb iCvfcl^tJLi (A*‘^ufa
(d^wv tu* y c f * y" <^Hr *?£>
<4ww /l“A*
^i,.-%w^4.. ^A*=j P , '|vVV'\. 6WV C?
\$J CttsU *A.0+ f &{( /fix fei L \,
j ^ \lxl&4- rKu k t^w-'IVV' CLu,Ct„ Jr 4a
p r r ux-dfa' Ut-izwu Ui d
y'‘fa L “ £ - twwi ^Ce *>4- t v* /£? $r
cA v ^ Cwm (uXUJt^-v ^ (V^ i~v/).^j
*' v " c )p<v*U <£*-vM Fa-lit, t kr
J\&*rfc- ) Cisti, pvwi' (fa.
/ ' jm* 4 Fu^ b*w-fc / ttv4 m 'ficfa-i)
£ J C/lv — At*V\ * nUl,
f H\- (m~0 iMaJU-M fa^ tr C(a U
I , ti v U > *• ( l-1 O-Lpx* ^ &&-tt ]fT~l-■. i l-
4
Jjl f Ft vj tcF^ F
6*^ i'v*r"
^ - u *** 'B*K4, JxtyVi. 1 rfit Uh^
0 ^tXtUui , f-VA 6^"|*-Wv j^v t ttA
wm - 4^wv ^ | if^fa
CU to
\\lfa V.VVY gVV
tsA*
p^v>
Mav^ rfj
Vv'vV'-j, wk*
/
k
I/J £*?V» •■ t * / *trf' L ,
■*&<-
fnajLoU, ln/rUJ>
4 j~yrt^L. £01,0 Cststt. C^io^Qj^sisis^^
, ^JL *- JUr~3^ fi>*S
AsK
§U(f- '</ ^ #
CUl t4\ Q'rxJsj f/W its- &b-> —
<r^6
A
CA*~ &ULA cj {Lt~cs& ^W>* —
' *rr\**t
Al^ts^x v ^ ^
r-r , d^tCi^tc*-.*- - ^f^L
/h^s *4 4^/ e, '»-
j — &t*~ J fist*--'*-4' -£*+*yp> *■’
^iv/i - A^J'y -*■’ ^tz-t-fc ity\c^Sk- /Yh a*
t\A. Ot/'t*sr^is- fLsf'Vtryp £vv-^v-o Q £*?*■*■&
/W^ h^A - ^ A* 4 *; C4»*fH< U4*» —
J /- - ’ /* fiiLltk A **JU . . I
«4*tii A **c*Sl^ « 4jfi4sW-‘
,i ** /* ' ^y& - £ k ** - ^
Ar
'?>'vt-c^ 1 X-./'*-/4-y^i * ** t/~u#f£ fi*/ 1
ty*U mW>Jj fiUU*r+y$ i^n ^yUU'£> I
Ouv^jU^J^ eU^^4 - yfr^O^s
fsKrtm^ 4 •***&*« pU,Mt* rC-
^jLcstJZd, kcA^bLflL^fy^ f\r.yvvUytrK-(^
pfi^ t*s%wU - Jr^Y^' *"' {
^ t-v 4*Ll* £■ 4w i, '*' v ' ^
£>w#l
Cfiyyt^ i ^i. J> CV'X^^^W
PUi*f 4 Ci YY
4Zst*y+i & A^d (tmA&X. fet* ^
/fvi Ots*-^jv^C ^ f tj
JLA**> faU*
/)W£^> y-j / T
[/l^yi/i As ^U/rv /ti^lAf £A>
/p t^rSn A,^
/kCt-L% — *^tcj} /> V 1 ^—<- J‘'is*~-Crt
J £*"$J f ' f J* 7 ; t f -v n ^
/’:■ A- *— '&0k*vf &-^vtZ* fr %'
>w ft"**' jf m *4 ffa&'Cul
n^t^ '^/u^C /^ ju-T, w+-££.i£** j isj
fty# ]~ 1*^4 4K4\.L $*4 j& *ux » /3 -t^t' iv« y-a-^v,
*l ’ft \ ) '&' ! £ l &~ > '" t''J'l t^- ■ v’ v 4l_ __
■inc
C>4&H* I ^---c. &-£•■(■ Vu>
f~hx Aictx foyi^C ^
• 1 &M» A\<Ch 0<4t*r» (Z( t-e.<y ftr-c*.
> fl &****-fi-Ct- X l /? t is^otx
■ f^at — ^ ^j^ert- / £w-e. _.
-O' {iiU*t£> £**+■ fjtti
iM 0 £*<$i j^-v'Sp (^K -V< - <^>-V 1/Ci^yj
I£1^ J /‘T'V U^ f i L I- ^ "" j y ts£j$r y^J l 4, ^
^^ ^ /4 #*- p ^ ^5 £" v-/t
A<y t >j *4j ^ (A' !‘%/1
fie**- 4W' A vj-v-
® /j+r fcr&r* Q*Cis-V*£&%-* \ -y -t •• i v
t> - l'j £rtJC&{ &r tU^C- ^ j« t-, 4$
f*y £-#•>•-*- * t^u-i
t/^ &l++~LrO‘£ &•'£, <S>^U, - ... Ot^)
flU h Ctcu^ ksuA (/>^ b c *-’~ $ ~- >/
1 ‘ *
P
f'
•^t .•
•4
n>
ru v
^pj) iO/VT, Pt. t - v ‘
/U^i- £, -/ /-tr..Mr fa, 0^} t } fa
eftt C~ — *./ /} , _^-" i I
(y- c_- r\ tf l 7r>v # .V
^t. ey>y^ — sgAtxy
/} : iA m-j (l,%. jpr+^L -^S^» ^j.,/Jv*,
^ - /w &€rtTL ^
7 A sk^U/b _ Lfrlst!
fi-’t-f 'CCs) , l^c tuu^^ /UuA
^V /t c^tsh, ,^.j
h^A^jr &Lv$ j&..£,e^u. ^ fa otZ'^ J%*\,^^
AwV frHu^cp /7 A'- U+./U &*-+■ &K3 4* *■ *i 4
/£< £-?-< ^,/v,. J^ , /^A^*%. 'i < '’' *
iH'iltPf^ J-Jf ‘^v /)
/^ 6inf7<? /SW^ cfl ***£& ....
/>/**'»-- /T^ 4 h'>^- £ ^ - ^'V t 1 / !■> *-
/}i HVlA v*^‘3 ^
"- -f. Iaj-'L 1 ^/^ ^- i *■ i{/ 2 -t-i ’***•
r>' f p* <u £~ 4/~p^ - — sfcy&^h d^y^
■ „ ^fr^ts**£cC ~C*' £yk *L : A**6*
Pb+- t* * J 4 *r**s &A*¥ l**<>
* sln^ tc4u> O^fij^ ' : -
/W /iu%.‘c*. cj <^r /1 * ; / & 4 ;ik
j~ ' iLa-'V •l'i\.i r ^Q ,* ,
$L - ' {kvb p }Ui (2^p - h~**~ ^ ^
/^jiw*wu4 D^- v U OfvtWi lr k
£/^ p*^v|0 Vp^uA* — £*1 ',,.«w [kv*^
yir h? i.C^ri\ut*<r fy
3 - A h\-Csi+A^K ui^x-tA,
(A\M. f — I'W HrVYvC' la. £v<~C fo~T~l**£Lf_^4^
— £Cv- $ tc, /) — j- 2?*S» w-'Sf'i-*— lv|^
fov^ A. ItrW' qA/gAa^a** •
"t j \ — ^Hua4 k
LGu**? j <Xs^-() L cJt wT
iht A*^ ^ ^ r y x ^ fcvtw I&*9 ~cA“A
^ ^ A*~# fa^CALs lc' 7 'U't^u Arxt- y
ilf- v t~A^y}\,0y P At# aa- ■»»
^ ^K-vMUil ^ ^ ^ '« ; i\{ / A*h. ^
J 11- / ^~ U } "T^j fash, -
J^Uvp .(A fa/LKu&c- lHs'
^ A* v vt^' fr't/~r\s*~ fitiTU/yis-i
A^trT*A'~A-*-. A'^Otsur^ • 00 '
H ryr ^m frufc, Ju£up ^ xl/Vx-v
Jb-Urh A^^nrvHM/t &> fi$%ZZ^
A^vwfvv<*1r^'*Y^ l^t /ty f
C#>**yib — ^4 & r f** : y}
jAfi^y, - 4*^* ✓*•*// *%* /(,-£& t*3
■"-’. i /-£ ™ ^^v'V' {te'f&u £cha*s&l.*
bpk* Uaa &4rl£jx~ 0\uA/^i^
/-*^‘‘4 &4*i AtA4f^\tJ, ixu jfe-' /(r/f*.
( 47 )
Liability,
Causes,
Variety.
Signs.
Diagnosis.
Prognosis.
Treatment.
HEAD OF HUMERUS.
Liability.
Causes.
Variety,
Signs.
Diagnosis.
Prog7iQ$is.
Treatment.
ANATOMICAL NECK.
Liability,
Causes.
Variety.
Signs.
Diagnosis.
Prognosis.
Treatment.
SURGICAL NECK.
Liability.
Causes.
Variety.
Signs.
Diagnosis.
Prognosis.
Treatment.
SEPARATION OF THE EPIPHYSES.
Liability,
Causes.
Variety.
Signs,
Diagnosis.
Prognosis,
Treatment.
SHAFT ABOVE INSERTION OF DELTOID.
Liability,
Causes.
Variety.
Signs.
Diagnosis.
Prognosis.
Treatment.
SHAFT AT ITS MIDDLE*
C 48 )
SHAFT ABOVE CONDYLES*
Variety.
Signs,
Diif.g7u.mis.
Prognosis.
Treatment.
Liability.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Variety,
CONDYLES*
XII- BONES OF THE FORE-ARM.
Liability*—Styx* frequently broken than the humerus^one-fifth of all
fractures.
Boms involved.— One or both may be broken* The radius is most liable,
from its connexion with the wrist*
Causes,
Varieties,
BOTH BONES*
Parts generally broken.
Causes ,
Variety ,
Symptoms.
Diagnosis.
Prognosis.
Treatment*
FRACTURE OF RADIUS ALONE*
Liability .—Very common*
Causes.
Variety.
Parts usually broken -Head, neck, shaft, or inferior extremity*
Symptoms of each.
Diagnosis.
Prognosis,
Treatment.
V-,> I
^ flyrt**)
Sty?**' — , i-^iO
<Ce- J-iL-m ,*■■*> /Ji-l&S ^ /%.
0^^ - ^ -—
/ - ^Pj/'s" * ft* T * f *- m # j$
/Cu* ^-y * }?b#4m
'U'l? TcHj? *-<c
6?u> /r^y
i** yL+i,t*s > £X'C*>+»f'€*%i* gf) sSuk.ypt^. £v
.& ^ t '* v ^‘' «*f C4<)\ wA^i ^TU*
e~e+*%dr1 pr*%*£- ^>-<x-p '/&**,/&+ htsL^Zt-
fi— j/Li .'-i^4#4-^<'£^*^--*^V" — < 6isl*+. fy ishd-Ur^si 1 Ul~~
jUXlX^ — &**- i) (A- ^
^ ^G***- 0 *-* /Cl4* ' ^Hrnmt * £/-<£--0
f ^Yf w d - vw h4 y-~ f
(y\Ayis<*<s t cJhZZt^ t-!<-v/ o'CaC r y ^
J\ x /;'( (X**S»»^ /9Lc^ 4 L^*— *3fc^4-V 1 -*/ ^^ l' t ^*^
'py^-O'^ Ly. CtwtX fc'lxl^y-* <tyftW
fiy' f ,tdf PuAf?C U y
'* *'+; Ack^-.. _^
(W/vwf Up-'t^L^ fyp'k ixc^S 6*-e*tdU*
jp-yMu^ £*- f ■ lCi^J-c^4 ' (yy $£// ^lA, ^
CT
bs^C*~**rL t^C* ( {^d i\ 4 Vv (%I C ^
/TWj *- f tis~> /UC d^r- j> v x-c. * <j
— flfyvirvrv £-44 CC'C» £-
(mM> *^r
Icriy/V-* t*-
\j| (^vvujp^
$ c uiM &*j**»- je^d J
ifo ^-**w i)
O-
'~ter$ A 4 ~ £ ^
/}"t /ft &K* ^ «^.-{l<W'“->' *
■• /hi €r. r
*•■*&*& ^- fc 'C- *•
_ ,X Ju^ -
<4 ■ 1 Hfc*/ '^W' ; ^ /r;' C
I /’JtX^/i'**' £t' /iw*vu
ivx /stf~Lo /fc-’^--'Z%^- —
/u -'- r /t : '/t-t - /^t fc
■ ficCZt***# • £j Sc^'*- d»^^/uZ:
, /*v^i %>£ £t£#*~£s ~ ^ /t-* Cc ~£"
{fj'&'iU* /&—&i it<i /0-£df£^t.‘*y
m U^tJfC ifel ^ £■■ &/r^- ; 4$ iOt-fs* v £ J
B.* {£k*~£Cc&ra - G*d <£*.. u -/■
I /‘' AitV** Cf-t^ '^'•J &’^%d r 4"; " 4^'
^V'^’ 4 <^? JW&-*-*>■'£ Jcx v .’A '
I ^ v ; , **-*? ^
r <XA x! y / ^x 4/3
^ >>^0 * #(■?.£ jo i tM *
Ip
£si~- j z- '~ *^ fL t)
Kf
&^f vL $
/
,ri -*- P &*■
4 /t.
>'A
/ $£l* (Lfr-r^* /' £ i'-U A.-t i'i^
* TjA /fiT J / /> / ..4 ^ *
d- j /- '>
/
''jhfirt*- '* *
,5
y V-w-ct'V '
•#Vi
^ /- /• /, r. J>C
irl
t # 4 ) -
j/|> • USfc*?
>MU
I - - p 4 $r% rv^-CUU^]
&H { £/v /vv’^
o- *fO# - c 4 v
t >- c t-w^ L .o ti\/f L- 4 ^
hv~i~ ^ fi'*< , .. &
«—• i ia £$C** ■ ^
^■■ ^{jf)(/ ( i C &/ 0 ~ — ^ 9 -c^/ v-Ct** &
(m/v*AJ —• 'Vc £6£? /* / fc, J\UsuJ) £t>cS fo
(Z/w* <s/vw./ ^ At^v. -—- \
! f t\CU/y^Ctk+v** eft bfteC S-K h OSlCZL*)
'hfft
tSt&f* feet*.*** jSU\f'tfeiZ'+f*
— J-6 w ^ r #u a I
-C -
AaW> _ . — , ,- _ —-..
yi'l.<t,&.A. * £tT'C£5fa &V '*-^'7w.—»t. £t ^
f-iA-f) I -Vv t^f -/wm,. ; ^ fc a-**—
^//4u^ &L<Asfj £Art fot*« i
J\^^ y. •^/V'’ —» _ '- '- f) £ Ci ^k — #f PWju
£Xs~ir “~- £sM~ 4> i/U***\, »■ 1 /^ (l~Ji**-ysfr /*
Gt^Njr
V ^ v — / —- f - ■—■ --"T
£u*^) t^iX lu 4 cf^X Ad pr* * '
Si yVc»C^ ^ /&-■<*-££;£ f |
^ ir'ow
d/i-Zut^ CCrt^X). r j* f t '14 l
MW^
t ^ ^ £ .€,.-■ t-v..-/ £ i\.i *
$-*VW^> tv ^ '/U-S-r^ fi£+*Z. r 0b*.£i
X- £ - h ^Vvwjo /V*SuHf V fp'v^i
< U ty) * fy*&+ ^ ■ - d Owl
/ p.- t r Sj. •**** 'J)r 0 l**~ i**\* [ &/^ , d ti tX- 1
1 C ^- w fajsf X/5 v ]g f\ '
iA/ 1 - ^.^c—jvu-0
■ cLxJ f. <?-J /w ^
ml i
^ fXtoJl i/Y\- <>t^
p Y^'fj —£%■- f3/ f' ; • 45 ”
$lAf<^£ -' ; ; . v^^v jS
. /\ V*v-f. I VS ( y£j u g> &aJ()
■JC-C- ; ■/• — jO £ t/{ " « i >.I'"0*'’ C-t- L-**
*. jjl'i'J ^ #'^ fc Us~t/Ptv~ { [A/'
■ /l4*jS*-w- -pC^H / J, X4t^*^ v <y w ' '
. _ Jr
tr $ /•>"* *... ^ i ~ tU/A^'U
Cu**~d ^ ^ — J *
A- d * CC^ t-tA
Hi t . - fT^W4' id-vvvvJa-6^ Irn^.
W-t) »* ( /,vm
tr fw£ r l:V'*t tv, u^/'t>-vv.ft'» <ll
! j \ gv^MU'—* *«A, — ^ A.4AWS. 4v -r *"U_>
■
4 A
■h t c
«
Ji Ia *"« - „ ,
.••*<< » Afajt - Uw' iv' ••- -- - *
^v -i
4 4vw*
Id $ f*'*'
iSL<x
u
m. ,: K <• ¥- £ •■'■'?-'■t'-v *,.'
yfryt' v *J r+"-^t
// l .*~t‘'?~}"r (J; K ,^.|^l'i aA- / |
0l iv^. /iJ^-* J Jie'f ^iyv
♦■^-* «*jMvi' 4 v * * ■—
i i •■■'«'■ 4.4 w» «■■* '*• V, $
i^tP^jtftCiQ 1 $* : - t" &“«— 'U>W fc
^vU-i' ia|) c^- r - ^ —
4*c~ &4» / tc <*^
Hr V —■ $Lt4 CUm^
■. ' ■ /'
0
i
A
(\ l-t-d
yf) frs- /MsjJ fa~ti.y
V*JArs~ /\&- ■ /pfiL^SCZ*' f CW*sjg.jz,.cu 0 40
fc r \' x/ ^y~ ffidt— * /■ /■ iSL d ^
' d&inAyy^ - /u~ 2 rhf*i~-
^ t*j? -• (Aa. y? IjO yj&hrijusj
X tr*y cU{ - >*- tjm
A ‘ £ r _ w ,_.
r &/\s- }i-^~ J&nriA } — tdy* — l^-e*-&c.
Cbi — J Iro-csfi^- (*■ f -A'l,ty
*• y A-. (L(/X^I ^ £■' -/ ly t-t'fCy
'X%Z / v v x4,> , >- - fy\yt C'^y <■ f '£y t* \jt ct- A "t-■»■ *,
^t' r Tsuc^-&’£— » I'At'-t-*.' At -- 7
<TTr t y*-4 h & U* _ i^Aiv-i/<t*v4/ ly^. cyL
lltA/ / 1 / L ^-' !^ ^(sL U / «Wott a\ 1
<Jv A C(A\* Jl cAAi U.- C C< uy X~
£tu?A/) _ A : '&yi >'* <'■/' dlu
A ~to^(yt<y CJL*y ^ '>-, ~.i4*->'Cyj‘ ,tf r- i
#r* A/ lc .^ LJ^ C w — C^J •’:. {
1'Ut’l rfytAi i ih<^ }';^;(rii ., /i^. r *
., caJL 2 ^ i t i fy i^ / p?
C<~~ ^ (A*C-
Qh^>- ^ • '' ^ ^ v 7 *
^ c^ r J. V\wf^O Ui ( u /rc£/
/i \^. AA .vr'W (L^ 0 \ -x:U^w
v u R fjy*4_j J cvocd-
(K. f^JO^L *i /huA _ 'fotu*.
/j-o jp&SKjoJLyL - u4~*—>
. - /Vv^ ^ -
-5
A? r ^ *
/-* L,l e/fcZt. C*. ,
jKtyfrL &-{-o'-^~*<‘
GtA\A$
< S'-JaM^
/u — I'lw't- ^ Ivptsis *<
P^y^-'Kcd A' ' - r, LuJnstr' <7
^ ■ *>■ ' "
2t^lwvt I^s> ■i'-vy,-_L.„ iVt- !^ l £&* 6 * s 4
v^ QA\vL»' CtvvD'^W rAv- ^ e*-tjvM
iI'r.ut. <5W_£) (m,^ 0 oj^~ fr\^ u
ty~£ fi..\,\d t-0‘\/i^ r *"* (/ajiJJI n*
x-c^V l^Lo
j<£. (A-'^iCr ~~ /A^&k*** l L { ^CJ /- <VC- Hs a - k A/—
|L } »«U..v /<2wA - 3 *~J
|| fw ^fcAi/v*~ JkV'Vtff-vi _ (hC^ l*~r U
locMAlw fHvrfev f: ,j'!:. * < R
(wj-ii; ,
/ V '"\ Iw. Inr^ (rvM i> c cA 1
, ktU. ^vv^V ft^p'* vv.-v V /’ ^
| ^ ft Vti-frv- -• O- I'tH^vH,''
l^o | ; rv'Wvi^w^L-<>>^ 7 fK ^ f
■b Ctnlv JW^ ^ Ca| v P ^aXc O w<r c/t^c r^W\
: (; ~3 trRj^R \$esbfcsr- l&tu> ^ t-C |>v^
Rw^ p^R^\ t LWvaXiW .frv+p U*l
M\~A) D^.y WV-'v
v^l-v^ 'u >A
V^vjl V>^ o VC^ GiT^NA^v UWvV
f ' R) LiA CX/\/v~ vtvwV* o' V'--~6cAfed I
c/R. iyt ^My
11 .
^ \n>VA
h^\,wv i/i
( 49 )
Liability *
Causes.
Variety.
Farts usually
process.
Signs of each.
Diagnosis.
Prognosis.
Treatment.
FRACTURE OF ULNA ALONE.
broken ,— Shaft, extremities, coronoid process, olecranon
Liability.
Causes.
Varieties.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
XIII. CARPAL BONES.
Liability.
Causes.
Varieties.
j Symptoms.
Diagnosis.
Prognosis.
Treatment.
XIV. METACARPAL BONES.
Liability.
Causes .
Varieties.
Symptoms.
Diagnosis.
Prognosis
t Treatment.
XV. PHALANGEAL BONES-
, /•
■i ^
i
* '
XVL SACRUM*
Liability,
Causes.
Varieties.
Symptoms.
Diagnosis.
Prognosis.
Treatment ,
4
t
\f /v-w — i->
■^4+~La~ ^*>"W /i <r<3c^j
f ^~C K. ^Vvc- ySt^C^nr^
-V w ' AaCC C i W^h CcrCZT <2^<^LX-/
^K-t/ w u-u^ £L ' ^C ^ _- l/^ (/\\^ /
fi\A? r 4^/^X^a ^ic ^C r,. yv-* *
V- ihno^ 1 / 1 /y, __
&c/y^y-4.*^ jrryvKs h /HT .£ tsfj U>
ItthXixS - / 'lOx^ v/ -4 c<^aL — ,f Ci y.
A^.c? </i/-t~x. p<A.i JL- VA-s.
jfe-rv dX^i? ^W'^j /s~ jC A - x -‘ K 'C) ll fc
fau/f farrw, t-i C Litu.<r* v
0 V ik^ Zi hJj K-cc- i^ lA>Hctu ff, W./W-
' (i^u A-c j-^-ij ' \ i-i- (rr-p*-
! * "---- y/^^C
ja G\/^\sy 0 *\^ r n affitc+t'
c/^w * // ^6c { —- V, ^ /(a^A \n -^~f*S)r
KXs^t£ u *~P * *| *WVVviU<--c. _ CaAS~AsVvl*.
£La^‘ IdUxj) —' iXtA^ ^ K
£a£^' £t> t2^<~4/ }l£) U-yLxt
y £*-// /Ai^x£(
/£/- * *Lt,c4
i >|
— A
j/^c c.*
/ CcAjo
fQ^q-u+y-ts A <? «-t <*-*-*(*
‘ft* krt^ff ^Vv ^ £,£ (
V A __
cy^ AA /
•U^ ^ ^ p^^v/y lr ' 6^c ••//$*t.
# ' (c
C-L.
S(T f. 4* C-*' /C^j /Q-njErr-
fei* ^^^‘-' - u~~>- ca^S^
\ , yn-u^r A<- ✓knifed? .
(&*4k HWUl» ^ 0w*&<4 y
ff 1f^'ifa> ki**sL
pr>- KStofa ^*vj«4|
—— i
H dvy. - jiCa fyA y ^‘ i -&*.tA‘
AMmk*^ tftujfo //^. •t-i. ^%^ tt- trfhiji v
yVx, ^y-tr-%' tftJ ^r\/>i^y "pt#i- nt
Avfe .—i?v v —- Q-£tpy
Ls/ <t **c* h£~c&* *-t-^ -
{fan** —- A / /Tvv^'v^*' A'y-' i/^cas4 Mc*^
l^i't^ b &y*~ \ *
T^ Gr' ls , J£/ Ojrf+foC^Gr .
\4*% JtyU~0~*+ A-**-e> j Gy
oL uJw /U^Hstu.^ sf yhca4
i^r^ j'k to ru/a-C— y - 0/ &M<P
|- ! wiv ^ (^XvV^ -kr/ /' ••'"
\*-rC<4/**> — J.^ Ct^^tki. /t'-n^f l'"^) fcu.
t/Zcip h (WiuL ; lyr*^- kM# ,m/|<
(Lr>^\ [M vL^fc ^ $*/vv
UA,a^
J Ct£? ©St- 5 4 ' V *
Uv* /■ jgp-y f ("hvfr’V-*- £- y V gr-p:" U ■ P'U. *vv
e4f^\j r jpnrt^ €\*n,&y
^CitKb f ib pK* "- ^ GJ 1
P^l'XS^' Ov'l^Vv /W - '^ '» fos>* \ f~-tv',
J\^C*~* (■ £ ^ vW I &***" ]f / \w«yi—^
t'C* ^ A. v r ii ^-'V4 £r~ , tsy-i/jo
£* /; v ly Atlfc Ck.-w (/ jfck. Jv-'u^v-^
^-£nU 34^-- fit ■- ■:<: lb^ i\
%
9~- forHAsi- 'J h,
4~ i»N—v- Wir 6- 1*
1^4? - yy^ j'p<]
**4t />v ^ £/y j ‘i*t 4 *4
4f ^t/C'^r /^i **^ r *t^**i'\J $6*1/ /I'Vw ft
^7^ */ A^w, ~fk*^~ toC' fc^
(2^-u-vu . ^6-v r-r*/«f
^ pUAZl
^wf" /Vv V*v~- <2 „
f*rM>4 £Ly1r 1^4 ^
£y c- C4/)t- ‘t^Z~i> At /M
/Tw^Tf
O'V^^ *-'■ y^V j^ik*f' ^ a^'1 ^
Js-*a$ — /i^. x^t) /W^> /l\*7K 44^ 'j^d Jo/t*£-
~- ^ / " t ] w£""£/'T
/V- e-v —''/_ -O^^jo
^ iLs-«-~ ■JL'! tZ !' i.X(t^J- - ^u (Vwv^Z*^ ^ -
6^44^^* fa' vv ^ : ' l Y *r*Z j /u.ft-'t-***- Gs- t, j-t
UmZv hr- V 'Ktf ^t/-jA^>vv Jjfcj^ 'pO-W * '
\sj
&r^c ~ '
AC v
M
■u^ ym
/]yjy^ rft ~ 0 [i.^ /v /> r -* ^^4-vwC i£^L
Q-^fsCt^ Ts ^vffi. {hi^j C^-^Y' J > : t ^j/ *-• $0{? &U. /j< / *v
j^ LCsi i Lf <fi Lts*£t>'^ r ,
j?^-C*4 ^ O'U^f’j (& iu/^ i ft tvfr •
y
CrW
hi
O-'
flocUen
Vt^Wt, h> \W 0^^- 'j
<h\y^J’Mv i^. 0^ ^.. tfc.
—* /Vvwv**- QjlCXaz , C>-^-'*) In'^' t'-«“i-' •
^'fvwiv 1- %JrK' -v ^ V 1
(Kwv~ QxCXaj r &-~w iyvwv (/jx/v ('' •.
U) jxJ^S ' (pArMjb Jry^y^; S^C^l<^C CYc-v
U ..1 L L
f-Tr . PT'" ^ Y " s 'jf~'~ . rhw '
5*y 'WtVvvt^
_ _£}ii-iliw IA^ — <X-i ’- (( C ut
iXxUv^ /wvv(r fr*^ tr*~y£4 rK ^
t w-ti' v\£ 2Lu- 1**^***) ~ -s/tS'kvfi < i </kfc£
uj *V ^ faccf r %u t /y ; -
l^Ai ^ ^ 'i Ai^
A ^fu^^cL J fikzzx >
A< <Vc> J* /v.^ r >^Jj JjrrvjCtZ*^ h*-k cJT^Jj) -fax*
^;- j - 'l'~c^y d-+f}T "• *t-y^~ Js •— tusk^'U;
)>£A' *■ y <Wv<> *^f 1*ft**£- ^KZ- fax^ h.
^ ,--« . .-, <4 fXi t^~ y^ 4< /it i & U»*rCyQ
, k ojtr qA a. j+t^cX^x, j ^ yu*. &..„<? c "
- \,w C ^Ha'^cS ^
— $ 3 z (Si/^Z^^L d+'fjf* l jw-vl ^V^ ife
£Uv|.iA«£a. ~ 1/^t‘i [^tJt-L" h i IvvOli ^ o ■'-i*~ y !'it
K *“ f'V^"
\sU L-'-^' V* w v| \| ^.-^Y — iX* w -v»»V» ^ ^
1^ ^wyt Wfw /Ut^ tu.i+r*'.
lu. v^ ^^4-C^-S . <^\ Vvtw^ ft ^ v
(Vtu l*Av ^-tsviC Vv ^tCv'Xtn^ >^)V <Vyv£/lj
lr/.. jJ Va L' *Aa 1m** 1 •
XU^N'.^' *T
- v« r'- v v ‘w/^’ r •■ ■ a . /
(/W^tvii (/-v^ ^U r cV - - y —
fcV\N- yw^~ } ^ L -V; / —
//vv
f$ crl^ * (jtHur- {h-AJXu£i^^ \ /Kt>
$U^<$L Q&* o4&** y* h&^t Jtp->%~ b-€&r- ipu^C fii,
^ £#Vfc* £ +*'&£**
yi /lc</J At, **J fa On- -7huc M?*Cfr vA«J ~~ i/j^ /uitrf t*i~ A& U^-
4 fl 4 2 ^ ^M^tp. ft ^<3^ ^
l/tt* jCtA+t^h* ^
/£c J ^ ^ i/j
fsy*
i tt J $nr*»%,^ "ST &*-
^ /^Ti^iAt if far^'fcL
J f ,—~ CA-^r^ 7? A /fe # ^
^ Xt
C^/ ^ ' C
^ y^H-V **--^fv^3 %-W^”'/^W **
* V ^ Jlhv^Ss A 4L++, £t^Z
£ - d%^4,4 A' ^//C £%>/&, J Ci&y
fa>+^&C Act *s /L*Us^^ J St?SL<^ IcZ+A*€A^*
. *A*> £3j~~p/) /^Xvw// ^v <
^ ^Uvv^C Jj
*■ pt-*^* **"£ Ar /Ut&ti' /f U>% jU^^ A* K t+*+*>• l?
K *& £*j( / ^ V £/>\. •«** . ^
, Ufv& - jb-n f. - *^4> e^^P nV% $r^.A ' o i,
„4t - <=W\ ► <Jsf\,py' / l/ts* w ^ ^ ^*<4^
A^ lw( £^/^,|- ^.i^tli,
-3^2^ ^ 4"^ 6^6^* ^w£ ^-c-^4
- /V^ . i'Y bx.^fi &~t .. ,/r i*-^
^■> -v vtlct,^ju? [t^iy
C^t-p jvLc^- • fete ^ t'W^v v
( 53 )
FRACTURE OF OS CALC IS*
Liability.
Causes.
Varieties.
Diagnosis.
Prognosis,
Treatment.
C 54 )
2. DISEASES AND INJURIES OF THE JOINTS.
General Remarks,
Joints most liable to disease.
Causes of Disease.
Effects on Constitution,
Classification.—A ll the diseases of the joints may be ranged under nine
heads.
1. Diseases originating in the soft parts, either intra or ^particular,
2. Diseases originating in the hard tissues of a joint.
3. Affections which may be considered as products or terminations of dis¬
eased action.
4. Malignant diseases of the joints.
5. Wounds.
6. Sprains,
7. Dislocations.
8. Congenital luxation,
9. Diseases of the bursas mucosa.
First head,
<3. Synovitis—acute and chronic.
h. Hydrops articuli.
c. Abscess.
d. Elongation of ligaments,
e. Inflammation of ligaments,
/, Fleshy tumours of the synovial membranes.
g. Loose cartilages in the joints.
7i, Certain forms of white swelling.
i, Coxalgia, or hip disease,
j* Neuralgia*
k. I nflammation of the cellular tissue.
Second head,
a . Certain forms of white swelling.
h. Certain forms of coxalgia*
Third head.
a. Hypertrophy of articular cartilage.
h. Atrophy of articular cartilage.
<?. Eburnation of articular cartilage.
d* Softening of articular cartilage.
e. Ulceration of articular cartilage*
j pvy £/rT^t^^ _ t+x-t* £^y. c^'ptZf^ ' /. / t
A* ^ rl 'y ** k'<--fo- A( ° e^'f*~7^-ldLd j
^ • > y y
i-ayis-p, I'i'v /u-y.,<z. ^Jj) . _- .,
yj /*nwrf7\ *0 JPLP /t&Zc* &Cjfae. £**j&r~;
6*~ f,VC^in^rirz.'•^j, , ^ /fri**^*
fh^J-J 'n^X'C. A. £
-W {tVQ —
/U^^ Jtr_ of
► i L t ± ^\I^\ '^f't ^ y^ yz^t^cJ ' I
fl%*4«}~v-ty yp Cc^Zlj (y/i^H^c- fojfis&i _ _
yu*-$ yyurZ' 1 ^ *^ ^ ~
_a~ » $y7/^.t^ _
c'ljXset.J JrL^<±-0 Jj __ 7 ^ /^^ 7
I' /^l *r \£fidp* &6u ^ cJjj^ hx *t Ju (r&P. >-* {fj/L/1<.
v 4~^ &/za^ — a^) ferx~Js
. y&CUsU&Y'J /'^ dcpV^CA^C /la PjAaa]^
I /C *n+M- AtfaXg, ' " ■*“-*
<^nX /lAUyiit Zu -
■Mv^ n t*MZi ': ,"V’. ‘
r .
( 55 )
/ Reparation of articular cartilage after wounds* &c.
£ Alteration in the form of the head and neck of the long bones.
h. Collections of blood in a joint.
i. Chalkey concretions in a joint*
D Anchylosis.
First Head ,
I. SYNOVITIS.
Definition..
Causes <~l. Constitutional 2. Local.
Pirst) or constitutional.^ —Rheumatism, gout, gonorrhoea, parturition , preg¬
nancy, checked iencori lima, catheter ism.
Second t or local.- —-Blows, strains, mechanical injuries of all kinds, foreign
bodies in the joints, wounds.
Symptoms —-Pain on the slightest motion; swelling, redness, heat and ten¬
derness of the skin; fluctuation ■ displacement of any loose bone or cartilage
about the joint - and constitutional disturbance.
Diagnosis.* —May be confounded with inflamed bursae, but scarcely with any
thing else,
Prognosis -Varies When but one joint is affected—^when the cause is
local—when the inflammation runs high—it may terminate in ulceration or
degeneration of the synovial membranes, ulceration of the cartilages and bones,
necrosis, the loss of the joint, or even the life of the patient, tinder other cir¬
cumstances, the prognosis is rather favourable.
Dissection .
Treatment .—General indications. 1. Remove the cause. 2. Subdue the in¬
flammation by general and local antiphlogistic remedies. 3, Employ specific
remedies when the cause i% specific. 4, Prevent anchylosis.
II, HYDROPS ARTICULI, OR HYDRA RTHUS.
Definition.
Causes,
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment .
Ill* ABSCESS.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Dissection,
Treatment ,
' ( 56 )
IV. ELONGATION OF LIGAMENTS.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
V. INFLAMMATION OF LIGAMENTS.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
VI. FLESHY TUMOURS OF THE SYNOVIAL MEMBRANE.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
VII. CARTILAGES IN THE JOINTS
Definition and history.
Joints most liable .—The ginglymoidal, especially the knee, elbow and jaw.
Condition in the joint .—Loose or attached.
Size -Varies.
Consistence _Varies
Structure _Scarcely organized.
Number. —Varies.
i !lode of formation _Different explanations. Those of Pare, Monro.
Erlangen, Hunter, Cooper, and Brodie, referred to.
Symptoms.
Diagnosis.
Prognosis.
Treatment .—Two general methods. 1. Compression. 2. Extraction. Re¬
lative value of the two. Dangers of extraction referred to, and the different
operations, especially that of Goyraud and Syme, explained.
VIII. WHITE SWELLING, OR FUNGUS ARTICULI.
Definition.
Confusion in relation to the precise meaning of the term.
Brodie's classification .— According to Sir Benj. Brodie, all the cases of white
swelling may be referred to one of four different lesions. 1. Simple inflamma¬
tion of the synovial membrane. 2. Gelatinous degeneration of the synovial
membrane. 3. Ulceration of the cartilages. 4. Ulceration of the bone.
Ages most liable.
Joints most liable.
t « )
Causes —Constitutional and local.
Symptoms. —Vary with the form oflesion, Throe groups maj be made.
Diagnosis.* —Highly important to distinguish one from the other.
Prognosis. —Varies, but generally it Is unfavourable.
Terminations., —Resolution, anchylosis, suppuration, alteration of all tbe tis¬
sues of the joint, necrosis, the loss of the joint or limb, or the life of the
patient.
Dissection, —Depends on the stage at which it is made, and the form of the
disease.
Treatment.*- —Differs somewhat in each variety, but there are certain general
indications that will answer for all. The remedies are of course both constitu¬
tional and local*
General indications hi the first stage of the disease, —1. Keep the part at
rest by splints and position. 2. Employ general and local antiphlogistics if
inflammation runs high. 3. Prevent contraction of the limb.
General indications in the second stage.-^l. Counter irritation should be
employed. 2. Pressure as recommended by Scott is often useful, 3. Employ
alteratives to suit the diathesis. 4, Keep the joint at rest, while the patient is
allowed, if possible, access to the fresh air. Crutches and sling, &c. 5. Sup¬
port the strength if prostration should supervene, 6. Prevent anchylosis.
General indications in the third stage. —-1. Support the general health. 2
Never open the abscess unless w r e are forced so to do by peculiar circumstances.
3, Poultice the part after the abscess opens, 4. Keep the joint In a splint. 5, It
is often essential to obtain anchylosis, to save the life of the patient. 6. When
all our remedies fail, and the patient is sinking, amputate or excise the joint.
IX, COXALGIA, OR HIP DISEASE.
Definition,
Persons most liable. —Children of a scrofulous habit, from three to four
years of age, or from seven to fourteen. May occur in adults.
Causes.— 1, Constitutional. 2. Local.
First , or constitutional .—Scrofula, atmospheric changes, rheumatism, re-
pelled eruptions.
Second, or ^^.“-Mechanical injuries of every kind.
Symptoms . May be divided into four groups. 1. Those which characterize
the period of apparent elongation of the limb, with slight pain in the knee and
lameness, &c'. &c. 2* Those which belong to tbe period of shortening of the
limb, with pain in the hip itself, &c. Sec. 3. Those which characterize the
period *f suppuration and ulceration in the joint. 4* Those which indicate con¬
valescence. The causes of elo?igation and shortening in the first and second
stages explained.
Diagnosis .—May be confounded with—
a. Fracture of the cervix femoris.
b. Luxation of the caput femoris,
c. Congenital luxation.
d. Rheumatism,
e. Chronic inflammation of the upper third of the femur.
/, Sciatica,
g. Psoas abscess.
( 58 )
Prognosis —May be stated to be generally unfavourable.
Bisection *—The appearance on dissection depends upon the stage and pro¬
gress of the disease.
Pathology —Much diversity of opinion on this point. State my own views.
Treatment -General indications, 1, Rest and the antiphlogistic system
throughout the first stage. 2, Place the limb in a splint of such construction
as shall maintain the limb as nearly in its fiatural position as possible, so that
when resolution cannot be obtained, and false joint or anchylosis must be brought
about, the patient may still retain its use. Speak of Physkk’s and Humberts
method of practice. 3. Attend to the diathesis. 4, Apply counter irritants,
5, Support the health when this support is indicated, 6, Evacuate pus when it
is formed in large quantities, poultice, and support the health. 7. When reso¬
lution cannot be obtained, endeavor to form a false joint, or establish anchylosis.
8, After inflammation has subsided, and the limb remains shortened from mus¬
cular contraction, it is often useful to employ Humbert’s method of reduction.
Point out the dangers of this practice, as well as its advantages. 0, Protect
the limb for some time after the cure has been established- 10. When the
limb is shortened or deformed, apply some apparatus by which the patient will
be enabled to walk with comfort
X. NEURALGIA,
Definition.
Persons usually attacked.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
XI. INFLAMMATION OF THE CELLULAR TISSUE EXTERIOR TO
THE JOINT,
Cateses.
Symptoms .
Diagnosis.
Prognosis.
Treatment-
Second Head ,
I. CERTAIN FORMS OF WHITE SWELLING.
For the characteristics of these forms, refer to what has already been given
under the first head.
II. CERTAIN FORMS OF COXALGIA-
For the characteristics of these forms, refer to what has already been said
under the hist division.
#
-. .. :
'lliv^&yC^/u^ __ ^P\ wtat- y^^Hi
— f^ez&c, — J
Cy~ /-e-jsZ^/'*, de^-^ yl
y\*Sl-*4Si~~— ,/ty 'f^"£t ar J fvl &•*£? ^^7 -
(YHsVW^ *■ dj~ Li. o*4-4~£ „, — $-<4^/1-
j^V&C- _ £t-^J^) tfirlcZru.
Hr**** ufcr,
C 59 )
V. ULCERATION OF THE ARTICULAR CARTILAGES.
Third Head.
I. HYPERTROPHY OF THE ARTICULAR CARTILAGES.
Causes,
Symptoms,
Diagnosis.
Prognosis.
Dissection,
Treatment .
II. ATROPHY OF THE ARTICULAR CARTILAGES*
Causes,
Symptoms.
jn/ />. (Mj/i xi.it.
Frognos^
Dissection.
Treatment.
III. EBURNATION OF THE ARTICULAR CARTILAGES.
Causes.
Symptoms.
Diagnosis.
Prognosis,
Dissection.
Treatment.
IV. SOFTENING OF THE ARTICULAR CARTILAGES.
Causes.
Symptoms.
Diagnosis,
Prognosis,
Dissection.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
VL REPARATION OF THE ARTICULAR CARTILAGE AFTER
WOUNDS AND FRACTURES.
Describe this process.
( 60 )
VII. ALTERATION IN
Causes.
Symptoms.
Diagnosis.
Prognosis,
Treatment *
THE FORM OF THE HEAD AND NECK
THE LONG BONES.
OF
VIII. COLLECTIONS OF BLOOD IN THE CAVITY OF A JOINT.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
IX. CHALKEY CONCRETIONS IN AND AROUND JOINTS.
Causes,
Symptoms.
Diagnosis ♦
Prognosis.
Treatment.
X. ANCHYLOSIS.
Definition.
Classification, — 1 . Partial or local
2. General or universal
1. True or complete.
2, False or incomplete,
1. Extra capsular.
2. Intra capsular.
3 . Capsular.
Causes .—Most of the causes operate by keeping the parts motionless, or
nearly so, for a length of time. For example : diseases of various kinds, tumours,
fractures, dislocations, simple rest, cicatrices, injuries of tendons and muscles,
paralysis of one set of muscles, contraction of fascia, &c.; others operate under
all circumstances, as old age, chronic rheumatism or gout. Sometimes it is a
protective effort of nature, as seen in curvatures of the spine, anchylosis of
diseased joints, Stc.
Liability Gi nglymoid joints are more frequently thus affected than the
orbicular. Why ?
Symptoms .-^Depend on the variety of anchylosis,
Diagnosis ,—Cannot be confounded with any other affection. There is often
much difficulty, however, in the distinguishing one form from another.
Prognosis.— Y^ies with the character of the lesion—the nature of its cause
—the duration of the case—the age and health of the patient—the joint
involved, &c.
Dissection —Varies with the kind of anchylosis.
'■wtn dh
/Ut t' tT^Za s JfX &£Z/fal-u y
[% t hkbsfr iktPiv /U^yt (YKu^ iyK
Itrtsf. L(t ^ V. './ i' 'U
■pf* I r ^ 1 '* r * r is~ K K fV ^ VVpI^Y *V [ / •
* Aa * ly£t {*_/-* ; \-\ |q
pa^Kic, Aiuf* 1 *- . )\ Uu l*5k^*' j*A
V 0 *- />-o^lvVU,o — t| 6 ^v
p jiZ&j^p C*" f -o-'U-'f -V .i,i>— d Qjyi*’ / - ft/ ji-.j_^ |
!'•• tv^ «" (t-H/’f 4 <l-t^c. l/r '/-/[- A- Lr~n- \s*‘
( 61 )
Treatm^^Intrus anchylosis we can only relieve the patient by establishing
a false joint, or straightening the limb by cutting out a plug of bone, as per¬
formed by Dr* J. R* Barton, Never excise the joint, nor amputate the limb, as
advised by some ; nor should we attempt Louvrier J s operation*
In false anchylosis, the treatment is modified by the cause of stiffness. The
agents usually employed are passive motion, frictions, electricity, galvanism,
vapour bath, the screw, division of tendons , fascia and muscles, excision of
cicatrices, and some contrivance to take the place of paralysed muscles, as advised
by Sir C* BelL The comparative merit and dangers of these means explained*
Fourth Head.
MALIGNANT DISEASES.
The joints are liable to be attacked with malignant diseases of various kinds,
but especially with malignant exostosis, medullary sarcoma and fungus hema -
todes. For the characteristics of these diseases, as well as their treatment, see
chapter on « T amours** 1
Fifth Head ,
WOUNDS OF JOINTS*
Division.
Causes ,
Symptoms h —Vary with the character of the wound.
Diagno ns. —Generally, there is no difficulty in deciding upon the character
of the wound at once* Punctured wounds may he confounded with wounds of
the bursae mucosa*
Prognosis. —Depends on the joint injured, the character of the wound, the
age and health of the patient, the season of the year, and the possibility of
obtaining the proper remedy.
Dangers -^Inflammation, tetanus, caries, and necrosis,
Dissection *—The appearances on dissection depend upon the stage of the
disease, at which the examination is made.
Treatment.— Divided into—1* Constitutional* 2, Local, The remedies
must be modified to suit the peculiarities of the case.
Sixth Head,
SPRAINS*
Definition ,
Causes.
Diagnosis.
Prognosis.
Results or effects of the injury .
Treatment.
( 62 )
Seventh Head,
dislocations.
Definition,
Causes.-— 1. Predisposing or remote. 2. Proximate or efficient. The first
class may be subdivided into the local and general.
(1.) The local predisposing causes are_
“• Preternatural length of the ligaments of a joint, (see Stanley.)
i. Peculiar congenital formation of the joint,
e* The form of the joint.
d. Paralysis of the muscles around the joint.
Disease of the constituent tissues of a joint,
/. Hydrops articuli.
S' Tumours or earthy deposites in or about the joints.
h - Interstitial change in the articulating surfaces.
The general predisposing causes are—
a. Preternatural laxity of the entire ligamentous system, (see Delpech.)
>■ t he age. Dislocations are rare in the very young or very old.
(2.) Local or external causes,
a. External violence.
h. Muscular action.
Jrnntv most liable to luxation -The ball and socket joints, from the charac¬
ter of their articulating surfaces ; the weakness of their ligaments ; and their
subjection to the influence of a larger number of muscles, are more frequently
dislocated than the ginglymoid. "
Clmsifieation of dislocations -The first division is based upon the definitive
position of the head of the bone. Thus we have—
a. Primitive luxation.
Consecutive luxation.
The second degree is based upon the degree of displacement. Thus we have.
a. Complete luxation*
It- Incomplete luxation or sub-luxation.
The third division is based upon the duration of the accident. Thus we have
a. Recent luxation,
b* Old luxation.
The fourth division is based upon the degree of injury indicted upon the ad-
jacent soft parts or the bones themselves. Thus we have—
a. Simple luxation.
b. Compound luxation.
c. Complicated luxation.
Symptoms of luxation— 1. Rational or Physiological. 2. Sensible or Physical,
r irst, or rational*
a- Pain.
h. Numbness or paralysis In limb.
c. Loss of motion.
d. Constitutional disturbance*
Second, or physical.
Change in the entire form of the limb,
br Ch *nge in the natural length of the limb.
■Hi
( 63 )
e. Unnatural rigidity of the limb,
d* The disappearance of preternatural enlargement of the natural prominences
of the joint,
e. The appearance of unnatural cavities about the joints.
/. The appearance of a tumour (formed by the head of the bone) in the vicin¬
ity of the joint,
Diagnosis .—Dislocations may be confounded with—>
1st. Fractures.
Sd« Sprains.
3d. Bent bones.
Prognosis, —Depends on a variety of circumstances. U is modified* for ex¬
ample* by—
а. The joint involved,
б. The degree of displacement.
c. The duration of the injury,
d . The degree of injury sustained by the soft parts of bones.
e. The constitution of the patient.
/. The direction taken by the head of the bone,
Dissectio&j—* Appearances depend on the duration of the injury, and the
tissues upon which the head of the bone rests — State the usual appearance in
resent and old luxations.
Treatment.-—Gene ral indications.
1, The general condition of the patient demands our first attention* and be¬
fore we attempt to relieve the injury he most be placed in as comfortable a
position as possible, his fears calmed* and reaction to a certain degree estab¬
lished, It is sometimes well to deviate from the last direction* for should the
patient faint from pain merely, his muscles are in the most favorable condition
for our attempts at reduction.
2. As there is always displacement, « reduction 7 ' will be required. This
may be accomplished, in many cases* by the employment of mechanical means
alone* but often constitutional, agents are required.
The mechanical means are-—
a. Extension.
b. Counter extension.
o. Change in the position of the different bones.—To accomplish these ob¬
jects we employ the hands of assistants } hands * rollers * the pullies, and various
apparatus for overcoming muscular resistance.—The forces must be applied
steadily and slowly , they must also he equal and generally in the line of dis¬
placement. —Muscular resistance is often overcome by directing the patient’s
mind from the set of muscles concerned in the accident,—We must also select
the part upon which our extending and counter extending bands are to be placed.
Difference among surgeons on this point.—-The obstacles to reduction by me¬
chanical means alone are—
1. Muscular contraction.
2. The degree of laceration of the soft parts,
3. The shape of the joint.
4. The locking of the bones.
f> The existence of adhesions,
6. The interposition of tendons or ligaments.
( 64 )
The constitutional remedies employed, are intended chiefly to produce pros¬
tration, so that ali muscular resistance is destroyed; and the most efficient are ■
Bloodletting.
b. Hot bath.
c> Tart. Antim, et Potass®,
d . Fumes of tobacco, or injections of its infusion.
e. Intoxication.
/. Etherification*
Value of Myodiatomy in difficult cases discussed*—Also the propriety of
attempting The reduction of old luxations considered.
3, From the partial paralysis of the muscles, and laceration of the ligaments,
it is essential to apply sofne mechanical means to prevent the recurrence of the
luxation.—The usual dressings for fractures of the same bones may be em¬
ployed, for a week or two after the reduction of the accident.
4* As inflammatory symptoms may supervene, measures must be taken to
prevent their occurrence, and should they occur in spite of our efforts to the
contrary, the antiphlogistic system in all its details must be employed*
5. For the rigidity, which, in almost every case, is the result of the disloca¬
tion, the remedies already mentioned as applicable to the same difficulty coming
on after fractures, may be had recourse to*
6. When complicated w T ith fracture, always recollect to dress both injuries
before you leave the patient, and also to adopt the plan of treatment already
indicated under the bead of fractures.
COMPOUND AND COMPLICATED LUXATIONS.
After the reduction of the bones, the treatment in these injuries Is identical
with that advised in cases of compound and complicated fractures*—It is,
therefore, needless to repeat it here*—-The remarks relative to the dangers,
and question of amputation, in the latter class of accidents, apply very well to
the former*
PARTICULAR LUXATIONS*
L INFERIOR MAXILLARY.
Anatomy of the joint.
Liability .—This accident is common.
Cause, f.~l. Predisposing. 2. Proximate,
(1.) Age, sex, and preternatural elongation of the processus vaginalis.
Variety.
Symptoms.
Prognosis,
Dissection.
Treatment.
CL -
- j?y^ ti/hru* Jj cr^yi^’-'C-^cT'
*''*- it-Tsi ^ yT) IUC--4/ /'' h-A^t'^-fs ( < ‘s-
&-bu^ - OTr{jry -X
^fgoisLOnsuv - rt'H-TK'f l^,. „.
/£»--*' J\*/>uj,i,-* Ue u(f XZeVi ” Q '{a>L ~
o*.^ k 2 aJz*L . / y.
'/ A ~ 7 /_ ' 2 ■ y ^ - 1
X" itv^t It it.
irtinri (Lrffcu+f A^.* ^ ra*v ^
/si si Z^~T ~ - di^t^ ' /?/f'\vi / J^JL J t I ~J t~^-' _
CxZL~
IslAS*
L^L-£T<
^ &£? retry 7
* isr fr^ c _ r/j-^ y ^K^
A*- X /9>\. * ^ ^ * L * J Li /
/r'V iW /;* / //J /
_ // 0 K / z 1 ”2. ^ - //? Tv f'/r /W.4^ts$ \ r l r ~~~'
J&sA Xsh-i. -£ c _ * sL-a, gy} f- - i~u~*L
/fr~** *X < -*-~'' 0*U.**«- f/tuZ/LcJis f X> y- t
t .-^.■L<y Shc^Jj-Ar-1 y Z& JJZZZ
K->^ ($» X *4 . Uc — y /4 ft^Jtr*-^
\/hs**s4jl *C4.» ; . j At /■
^t'-' ^h»v«. Ltnsf 4u«-/ 4^4 L+eZk
/2^4*-< /«•. _''-4 t -‘-. a. cxsCt^ s f'y - - f'( /-
■ V* —
^ ^ /Z/ZZ\yr 4 *- e*'Ci m 4*** «•»
/v^-^4 A^4AX v wt_i/ /J-'tj't-VX" bcUJUf*^ u(s\
^tVtZZv'y' tCirv~ c 4 cy ji/t^ 1 A, ^ 4 . ;'
L^“
f '/£ X C^J t-( -L*L* LsV^y
ex, Z / ' ; / -
i“k Q fa f i-'f
6.^* ho ^ ts-L, l U
/tVVw c.J
ft'i/// u . c. <—-&/~X —^ ;>■ :--vv /1 A/ ,vv’ / ; j4„/ ___
fr~Ju fhn Lu
fy^L rvi *-y r- a
f\^Lj trh^, i ^s m o*~isCs 4*X*4c tc hss(/fa t '^
jry^s— ft LtUs^-*- C«v i * '»-- u v LcU
.vvv.lcL .4
t
fy\A
y
d<Uv
4*
A#.-**
U
itfa* rft/bd'f*'/lY*t-J*':A' (j~' /^t ;, (
&jU+ 6 *^!) /m^ t* 4 sJ. (< <
^tT' v * i '"JvSl. W 4 >€Z^c,j^/
E y^ ^ *s- />. ArX^
if/ ■ '! ^ j’^WVb
* f-tV4 v £^j /' ■'*'■■ C>/J. ^L^4 -x) j/^VtVxl f t. v l
#~H/j -** hLv '^ ~ -> U |
- $?&-..t.4 $4\ { p l* ^v<Hv hrtz^
,l w'twW - jTOrtA^t- ^uUA-t '^U'-^ jQ.it f, i •
' ijklAX. {,tJ\ ■ «- C-fs^-& \'L\*. - '- i J t j\/ { J\
|K.tv-W -M. 7 «v b&£<x* 0 * **V* f I
^vt^^ v " vvl 1 ^•/ ' l*~*j \ fa *•
K’V^y't- •**'<'"'-^ *•> C'i^vfvp
> f - v vv- ^ ^ !l i-t' i L ; ' /" ^ $ +*£/' ^
Inr .-■ /T : / fjj- 1 6 J f / : 7
■ : . ' ; ' ' ' .. < ^
H^U £ {,• !'• /*£• t'H I^V-W
I*,-#-.. U i H^ ^AV ff JbAoCi^ /Vut4 ^ <^C y"> ; L t—
^ W, •Li**' p4-cw-1 ^ j>t ( ^- • Pr t
C A ^y- - y ^
(5 Av it CyU -^stup — |>'UA^ $»
A-v.O V*> -JJ ^ VKC i'iw /I pkMj~
i tyU U w-c i* A, * ^ l '' e mj/UuaJ
V ii-r (a-^^w^L \ t (n ; /V j $/(■— jiy^K^ j
^-\0 ^ O'Ki Vivvtl t ^|4(vvV%^ —
CrU
./'i’-‘ ^ /~r •. -
6 Wf
(t-
r
10LC&-O-U.
. '. /&*_
| /jn _ M (fx$ C £) \s4-4-** 3
tA^/rUrf*' r • ■
^' f^t 1 V / I
tscJU- — rrr>vx^t 4 a3P^q £% y ^
J/C^ytyi^. jjrtrwnJ^ — t^f /2
Ji^idM^-^tiA p -V* /[a^, it'^fil. /fpL t |
/jrpY'£-c C £S1 *s 4~ l/TT^i^UsP
j3^L ^4^ 7>^. ,z /iv. ££_
jsL+ 1 ^
■ %.
t
/**u <*t^7 /^bty sf \
jftijt I* *i>£^^.A j/t^y d/lux*^ *,^ j^yyv\J j&tn*. ^ i
/t^ ^ 3 kr-L^+'t a ^ ^ ^ *^*"^7 I
7t^ t&cJ'i j 4. ^ $*vwp _ t^^Sw
: |^tv— ^ A**4c t^-'tx, ^ v t^t ('v / fbfC£ j* £
I ^p-^- ^ i £,Tv £r ~ !yj h*~
•' / ^ ‘'^ £C^3r^' K — ts ^ * V ^ f k 3^4k
'*<* ^~h^ fC tw /jchnrT? +*»
&-<.
^l-w
V " /<>•*• >/ J ; ' /^ +> f'b- ! ' r - r f'
. ' ft *. f‘ «rv t’(\ * l ‘t» <^C-V — ^
tsA~ i / j^-b^^<. A/ fr^- eL,$^<, —L_ -#■
. • > L . . f A/— ., t
I Uw -<,'{/.--vv,v'i ^ ’x£^
I
?
[
( 65 )
II. SUB-LUXATION OF THE LOWER JAW.
Definition.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Dissection.
Treatment. ,
III. OS HYOIDES.
Liability. m
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
i
IV. RIBS.
Anatomy of the articulations.
Liability.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
V. STERNUM.
Liability.
Causes.
Symptoms.
Diagnosis.
Progtiosis.
Dissection.
Treatment.
VI. CLAVICLE.
Anatomy of its artic?ilations.
Liability .— May be luxated at either extremity. The scapular is most fre¬
quently displaced.
Direction of Displacement. — The sternal extremity may be displaced in
three directions '.—forwards , backwards , and upwards. The scapular is usually
thrown upwards or downwards beneath the acromion process.
5
4
( 67 )
VIII. LUXATION OF THE HEAD OF THE HUMERUS.
Anatomy of articulation-.
Liability.— Very great, from the small size of the articulating surface the
weakness of Its ligaments ; the freedom of its motions; its constant exposure ;
and from its subjection to the influence of several muscles.
Direction of displacement —Downwards., forwards, backwards, and partially
upwards and forwards. Displacement directly upwards, to any extent, cannot
occur without fracture of the acromion. Explain the intercostal and thoracic
luxations mentioned hy Larrey and Percy,
I* DOWNWARD luxation.
Causes.
Symptoms.
Diagnosis — May be confounded with fracture of cervix scapula, fracture
of the neck ot humerus, bruises, paralysis of the muscles, and dislocation of the
biceps tendon.
Prognosis.
„ Dissection,
Complications —Great swelling; emphysema; inflammation; paralysis of
muscles.
Treatment. —General ind i cat ion s,
a. Fix the scapula.
b. Relax the muscles.
c. Draw the head of the bone to its cavity.
General methods.
a. Simple elevation of the arm.
b. Lifting the head of the bone while the arm is abducted.
c. Mo the's plan, or rather, Mr White’s.
d. Extension with heel in the axilla.
e. Pullies and bands.
/. Reducing apparatus of different kinds,
g- Myodiatomy.
It may be necessary to use constitutional remedies in combination with
either of these plans.
II. FORWARD LUXATION-
Causes.
Symptoms.
Diagnosis.
Prognosis. t K
Dissection.
Complications*
Deatment. Reduce to the first, and then employ the means already indi¬
cated.
( 63 )
i
IIL BACKWARD LUXATION*
Caused
Symptoms*
Diagnosis,
Prognosis.
Dissection. ■
C amplications.
Treatment.—Reduce to the first, and then employ the measures already pointed
out as efficient in the reduction of the former.
iv, partial, or subluxation.
Causes,
Symptoms.
Diagnosis*
Prognosis*
Dissection.
Treatment.
Causes*
Symptoms.
D lag no sis.
Prognosis*
Dissection.
Treatment.
V. DISLOCATION OP THE BICEPS TENDON,
IX. LUXATION AT THE ELBOW JOINT.
Anatomy of the joint.
Liability.
Direction of displacement .'-—Backwards and upwards of both bones ; lateral
of both bones; forwards of both bones ; forwards of the head of the radius ;
backwards of the head of the radius ; imperfect luxation of the head of the
radius ; upwards of the superior extremity of the ulna.
I, BACKWARDS AND UPWARDS OF BOTH BONES.
Causes,
Symptoms.
Diagnosis,
Prognosis.
Dissection.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection *
Treatment.
II. LATERAL DISPLACEMENT*
/* C S/'Z+y >^/ / V ^
^ J|^W^^^rTw/ d^wH^**** y*
J ^ Lt ' J>/ j ^ - C&xA ~
Wh**> 4-£>6
t _ „ MM*-tsZs£- ^
W &cd'Ct-ds I4to’»\p*jsti,c» fpL-f J&lr’/p r6t*4*y /£-%*’- / ij? .
fapt^O /i^o ^ty6\A4C£t*y Qls-ffc'l
trfAs i y/D j i/l* L/{'-£j& * LeJ& C < ■ , /
"'st'CL, Q„£c^ L*
yf l*P <v t-
7 ™'~ "•*/.
/rj ✓ a- .n /P &> 0 ^ 6W ^
8^ h, ^(JJ
j J"'(-- '8 // ^ tpt'i *' 4%fcy &?■■}■. •
6U^dflk&'o'h' / aJjJ'&**'+' 0tn^ /y A+tJ
fa M-et***'$ /
flfc joH^ /£f ~s) y isity 4-> Je-€u8}
y&U-i) fa*e 4 j 7 tts&.J) —- / €t<y„
fauzj (fpyrzrt-V kz^J^ [L '
(fi’ji. 88 - .-— yO^ Ly j/*ftl-/LrL/ ,
T/pisC-- V k ^p— ^ - ^
A*#>a 8 (X^CH'S^-Sz /^wt4, —- ' , **82-
fts*^t) y^J) £-#<*-/ft*t£s &C& £r/r&/
J"& ^ cu
/n^
p^0Cs /?uw
y<W / ; :
^t*‘ e$i
l '‘■’t-vvU'V UV-vf^ (
' pl^^Lr^
„ >
(j~ia
i»<3 6
(h'v^'V'4^
ffi) GL&fitiLrtr.'J'tf fill
1 GUtunu
h^'4. Q 'i'V (/
) rv>w
tKM^> (\Jj^L&&LS \\fiyy^,
/| (U.e^MA.W 4 ^ M4tw .
t,j3& f tit'K-'V
( 69 )
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment *
III* FORWARD DISPLACEMENT*
IV, FORWARDS OP THE HEAD OF THE RADIUS*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
V. BACKWARDS OP THE HEAD OP THE RADIUS*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
VI* IMPERFECT LUXATION OF THE HEAD OF THE RADIUS,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
VII* LUXATION OF THE SUPERIOR EXTREMITY OF THE ULNA*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment ,
X, LUXATION OF THE WRIST*
Anatomy of joint,
Liability.
Direction of displacement. —Backwards, forwards, and laterally,
*
I, BACKWARDS,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
( 71 )
XIII. LUXATION OF PHALANGES.
Anatomy of these joints.
Liability -All may be luxated, but usually the first of the thumb is most
liable.
Direction of displacement.
Causes.
Symptoms.
Diagnosis.
Prognosis*
Dissection.
Treatment.— Difficulties to be overcome are, i. Shape of the bone. 2. Bind¬
ing of ligaments. 3. Interposition of anterior ligaments, (Vidal and Pailleux.)
4 * Interposition of sesamoid bones, (Lawrie.) 5* Want of leverage. Marnier
of overcoming these difficulties explained.
XIV, LUXATION OF THE SACRUM,
Anatomy of joint.
Liability „
Causes,
Symptoms.
Diagnosis.
Prognosis,
Dissection*
Treatment*
XV. LUXATION OF THE OSSA INNOMINATA.
Liability *
Causes*
Symptoms.
Diagnosis.
Prognosis.
Dissection*
Treatment .
XVI. RELAXATION OF THE PELVIC SYMPHYSES.
Liability .
Causes.
Symptoms.
Diagnosis*
Prognosis.
Dissection.
Treatment.
XVII. LUXATION OF THE FEMUR.
Importance,
Anatomy of the joint.
Liability*
Direction of displacement* —The head of the bone may be displaced upwards
m three directions, and downwards in three directions, viz,: upwards and for¬
wards upon the dorsum ill!; upwards and forwards upon the ossa pubis; directly
upwards ; downwards^ and backwards in the upper ischiatic notch i downwards
and forwards into the foramen ovale; directly downwards.
( 72 )
I. UPWARDS AND BACKWARDS*
Causes,
Symptoms,
Diagnosis.
Prognosis,
Dissection.
Treatment .*■—G en era! indications .
a. Fix the pelvis.
b. Draw' the head of the bone towards its cavity,
c. Make use of the different muscles to assist in the reduction,
d* Employ constitutional remedies to relax the muscles.
General methods.
a. Bands and puilies.
b, Apparatus,
||, UPWARDS AND FORWARDS ON THE OSSA PUBIS.
Caftses.
Symptoms,
Diagnosis,
Prog?iosis.
Dissection,
Treatment. _ General indications are the same as in the first variety. 1 be
general methods are also the same, but we must vary the direction of our forces.
HI. IJ1RECTLY UPWARDS. (very RARE.)
Causes,
Symptoms.
Diagnosis,
Prognosis.
Dissection.
Treatment. _ The same indications to be observed as above, hut vary the
direction of the forces to suit the case.
IV* BACKWARDS AND SLIUHTDY DOWNWARDS.
' i
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection,
Treatment . —General indications the same as above, but the direction of the
forces must be varied.
V, FORWARDS AND DOWNWARDS.
Causes.
Symptoms.
Diagnosis*
Prognosis *
is S *
Treatment . —General indications still the same, hut the process must be
varied.
o o -tkvsj L Lt^y Zr.c |
;. *vf? ^ e*ksvL L r trt TiZo tcc^l -
| S4fi.^
2 V
«&» ^c4u~3.. *'$:>, /,
i
'-"1
■
r
i
*
■
.
■
( 73 )
VI- DIRECTLY DOWNWARDS* (VERY RARE*)
Causes,
Symptoms.
Diagnosis,
Prognosis.
Dissection,
Treatment —_General indications still the same, but we must modify our
forces to suit the case,
XVIII, LUXATION OF KNEE.
Anatomy of the joint.
Liability.
Direction of displacement.- —To render these luxations more clear to the
student it will be well to consider those of each constituent of the joint* and
first of those of the
I- PATELLA,
Varieties, — 1 . Outwards; 2* Inwards; 3* On its axis; 4 . Upwards; 5
Downwards,
Causes of each.
Symptoms of each.
Diagnosis,
Prognosis.
Dissection.
Treatment.
II, LUXATION OF THE HEAD OF THE TIBIA.
Varieties- —I. Backwards; 2, Forwards; 3. Outwards; 4, Inwards; 5. Sub¬
luxation or twist.
Causes.
Symptoms of each.
Diagnosis:
Prognosis.
Dissection,
Treatment *
III* INTERNAL DERANGEMENT OF THE KNEE JOINT*
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis,
Treatment.
IV. SUBLUXATION FROM LENGTH OF LIGAMENTS*
Causes,—Congenital or acquired.
Diagnosis.
Prognosis.
Dissection.
Treatment,
--
( 75 )
XX. LUXATION OF THE TARSAL BONES.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissectioji.
Treatment.
I. ASTRAGALUS.
Causes .
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
II. THE CUNEIFORM, ETC.
XXI. LUXATION OF THE METATARSAL BONES.
Causes.
Sympto7ns.
Diagnosis.
Prognosis .
Dissection.
Treatment.
Eighth Head.
XXII. LUXATION OF THE PHALANGES.
Causes.
Symptoms.
Diagnosis .
Prognosis.
Dissectioji .
Treat mejit.
CONGENITAL LUXATION.
Definition.
Varieties'.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
( 76 )
III. DISEASES OF THE FIBROUS SYSTEM.
r^ S r me f ° f l heaffeCti °, n8 ° fth ' S system have included under the diseases of
Sr? ; ^ reXam ^ Ie,DeSm ° dia ' andDmtasis; ^ars belong more par.
diseasl * ° if pract “ e of medlc,Ile tban t0 surgery, as rheumatism) &c. The
diseases usually considered as strictly surgical are—.
I. periostitis.
Definition.
Varieties -|. Acute. 2. Chronic.
Causes -1. Local. 2, Constitutional
First* or local:
a. Contusions.
b. Punctures.
c. Incisions.
f Extension of inflammation from diseased organs in the vicinity.
Second, or constitutional:
ff. Syphilis.
h> Excessive use of mercury.
e* Scrofula.
d. Cold.
Symptoms —1. Local. 3. Constitutional,
or Jo?r OS1, '“ Maybe cw,foundedwith ostiti3 > ^ries, necrosis, rheumatism,
nZ r 2Tt %~ i ” different ca3es ' lTsuall >' the cure is tedious; it may
nevertheless be considered a very curable disease
*!*-“•>« intensity »d
•JHHHflUl- .IS*?' '“'“Sinn »t Iy»pki inJumMtta,,
tllage ” of the El,b J acent bone i conversion of the membrane into car-
Treatment.—The remedies are divided into general and local. Both are
modified by the circumstances of the case.
First* or general
1. Bloodletting,
2. Active purgation.
3 . Low diet.
4. Mercurials.
5. Preparations of iodine, especially the iodide of potassium.
B - Oecoctions of the woods.
Second, or local.
1. Leeches,
2- Free incisions,
3. Poultices and fomentations,
4. Blisters.
5. Iodine* or mercurial frictions.
6. Woo] and oil-silk dressing.
( 77 )
II. PARONYCHIA, OR WHITLOW.
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Termi?iatio?is.
Treatment.
III. TYROMA.
Definition.
Varieties -Partial or general.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Termiiiations.
Treatment.
IV. CHONDROMA.
Definition.
Varieties .—Partial or general.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Terminations.
Treatment.
%
V. OSSIFICATION OF THE PERIOSTEUM.
Varieties —Partial or general.
Causes.
Symptoms.
Diag?iosis.
Prognosis.
Treatment.
VI. MALIGNANT DISEASES OF THE PERIOSTEUM.
Like all other organized tissues, the periosteum is liable to be attacked by
the various diseases termed malignant, the characteristics of which have already
been or will be described under other heads. 3
VII. WOUNDS OF FASCIA OR APONEUROSIS.
Varieties of wounds.
Symptoms.
Diagiosis.
Prognosis.
Terminations —Inflammation, sloughing, suppuration, adhesions, contrac¬
tions.
Treatment.
{ 78 )
VIII. CONTRACTION OF FASCIA.
The numerous fascia and aponeuroses in different parts of the body, are all
liable to undergo a chronic thickening and contraction, from which results a
variety of deformities, many of them very difficult to relieve, and others
entirely incurable. Ghidella and Froriep were among the first to describe these
affections with any thing like method or correctness, although the disease was
:ong since spoken of by the ancients, as ffcrispatura tendinum!” Sir A.
Cooper, Dupuytren, Goyraud, and most of the recent authorities in orthopedic
surgery, have likewise carefully and correctly explained the nature of the defect,
and also the most approved methods of treatment. We shall describe brieify
the most important of the deformities resulting from this cause.
I. CONTRACTION OF THE FASCIA PALMARIS.
Anatomy of the fascia of the palm of the hand .
Deformity produced by the contraction of the fascia*, or fibrous cords attacked
to its inferior ^.(Dupuytren and Goyraud.)
'Fingers usually involved.
Causes of the contraction —-1, Congenital. 3. Acquired: and according to
Dupuytren, the defect is occasionally hereditary.
Diagnosis.—May be confounded with retraction of the fingers dependent on
other causes; as contraction of the flexor tendons, cicatrices, fire.
Prognosis —By no means in every case favorable. It Is, however, often
susceptible of relief.
Effects on the adjacent muscles, tendons and ligaments.
Treatment. —Three modes of treatment. 1. Mechanical extension. 2. Fric¬
tions. 3. Subcutaneous section, followed by mechanical extension. The merits
of these methods discussed.
n. CONTRACTION OF THE FASCIA CUBITI.
Anatomy of the part ,
Deformity produced by the contraction of the Fascia .
Causes.—1. Congenital* 2. Acquired.
Diagnosis,—May be confounded with contraction of the tendons of the
biceps and brachialis interims muscles, and inflammation of the joint.
Prognosis.
Effects on the other constituents of the articulation.
Treatment —The same general methods are applicable here, that are
employed in the other fascial contractions.
Ill* CONTRACTION OF THE FASCIA PLANTARIS*
Anatomy of the sole of the foot .
Deformity produced by the contraction of the fascia.
Causes. — 1 . Congenital. 2. Acquired.
Diagnosis .— May be mistaken for common talapes equinus.
Prognosis.
Xtifects on the tarsal a$id metatarsal artirnlations ,
Treatment .— The same general methods that are required in contraction of
the other fascia.
( 79 )
IV. CONTRACTION OP THE FASCIA LATA AT THE KNEE.
. Anatomy of the joint.
Deformity produced by ike contraction of the fascia.
Causes ..— L Congenital . 2* Acquired.
Diagnosis. — May be confounded with contractions of the tendons and mus¬
cles* and also inflammation of the joint.
Prcgf 0 S is .
Effects on the articulation.
Treatment, The same general methods hold good here.
IV. DISEASES OF THE BURSJE MU COS .E ,
I. WOUNDS' OF THE BURS.®.
Varieties.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Can see*
Symptoms.
Diagnosis.
Prognosis.
Treatment.
II. INFLAMMATION OF THF. BURS®.
*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
HI. ABSCESS OF THE BURS®.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
IV. HYDROPS BURS®.
\
f
( 80 }
V. CARTILAGINOUS FORMATIONS IN THE BURSAS,
Causes.
Symptoms.
Diagnosis*
Prognosis.
Treatment.
y VI. GANGLION.
Definition*— Encysted tumor formed in the course of a tendon or its fibrous
sheath-
Symptoms.
Causes*
Pathology.
Joints most liable.
Diagnosis*
Prognosis.
Treatment.
1. Stimulating friction and blisters ; 2, Compression; 3. Seton; 4- Puncture
followed by compression; 5. Rupture of Cyst; G. Acupuncture; 7. Extm
pation,
VIL BUN YON.
Definition *-—An inflammation with thickening of the bursa mucosa on the
inside of the great toe-
Causes*
Symptoms.
Prog?iosis.
Diagnosis .•—Dislocation from Gout and Rheumatism.
Treatment — When acutely inflamed, leech* and apply cold or warm poul¬
tices, and elevate the foot; when chronic inflammation takes place* blister and
use iodine locally, and avoid pressure on the foot; when suppuration takes
place* let out the pus } and apply a poultice.
When the bursa become very troublesome* it may be dissected out [See
Erodie.]
VIIL HOUSEMAID’S KNEE.
Definition.
Causes.
Diagnosis.
Prognosis.
Treatment.
J
( 81 )
V. DISEASES OF THE TENDONS,
L WOUNDS OF THE TENDONS.
Varieties,
Causes.
Symptoms,
Diagnosis.
Prognosis.
Mode of reparation —Depends upon the nature of the wound. In wounds
exposing the tendon to the air, the process differs essentially from that which
takes place when the tendon is not exposed. The degree of separation of the
divided extremities also modifies the process—(See Velpeau, Ammon, and
Bouvier,}
Treatment.— l f Simple position and apparatus, 2. The Suture, aided by
bandages and position 3. Antiphlogistic system. The apparatus or dressing
must be modified to suit each particular ease,
IL INFLAMMATION OF TENDONS.
Varieties —Simple, rheumatic, or gouty ; acute, or chronic.
Causes.
Symptoms,
Diagnosis.
Prognosis,
Treatment,
IIL OSSIFICATION OF TENDONS
Causes,
Persons most liable .
Symptoms,
Diagnosis,
Prognosis.
Treatment.
IV. TUMOURS OF TENDONS.
See chapter on “ Tumours.”
a
( 82 )
VL INJURIES AND DISEASES OF THE VOLUNTARY
MUSCLES AND THEIR TENDONS.
I. WOUNDS AND RUPTURE OP MUSCLES.
Varieties,
Causes.
— a
Symptoms, V- -
Diagnosis*
Prog?iosis*
Mod* of reparation This process is modified by the exposure or non-exm.
siu-e of the injured muscle to the action of the air.
Treatment -l f Rest, proper position, and apparatus. 2. Suture, or straps.
and bandages, 3. Antiphlogistic^
II. MYOSTTIS OR INFLAMMATION.
Varieties*- Sim pi e, rheumatic, or gouty; acute or chronic.
Causes*
Symptoms.
Diagnosis*
Prognosis.
Terminal ions.—Pa ! s y, irregular spasm; suppuration, (Myositis puruleqta;}
softening, (Myositis emolliens;) hypertrophy; atrophy; hardening; and oss'fi-
cation-
Treatment.
III. SUPPURATION IN MUSCLE,
The symptoms indicative of suppuration in this tissue resemble those already
described under the general head .< Suppuration,”and the treatment is precisely
the same as that proper in cases of suppuration elsewhere. The most striking
peculiarity of this action here, is the circumstance of the entire muscle often
disappearing, as in psoas abscess.
IV. SOFTENING.
ihis condition of the muscle may result from defective nutrition, a s stated
> Laennec ■ and also from i?iJiammatioH> as Eouillaud has dearly shown. The
muscle becomes pale, flabby, friable, and easily torn. There is no remedy tor
the difficulty* J
V. STEATOSIS, OR FATTY DEGENERATION.
■ Thls ^S^tation is exceedingly uncommon, hut cases are reported by Vici],
t Azyr and others, in which the muscles were reduced to all the physical pro¬
perties of fat*
VI. OSSIFICATION.
1 his is seen in old persons, and also in certain forms of exostosis. It may
exist as the result of inflammation.
( 83 )
VIL HYPERTROPHY,
This condition of the voluntary muscles is rare, but it occasionally occurs
from inflammation^ or excessive nutrition. It is also sometimes congenital.
VIII. ATROPHY,
This is a very important lesion of the muscles, and gives rise to many dis¬
eases, It presents itself under several forms. We have_
1. Simple atrophy —the result of long disuse, palsy, or defective nutrition,
2. Rigid atrophy .—The muscle is here shortened, rigid, Inextensible, and
lighter colored than natural. The diseases produced by this variety are club¬
foot, some form* of wry neck, contracted limbs, stiff jaw, &c. It generally f
results from spasmodic affections, or from the muscles being confined for some
time to one position.
3. Atrophy, ndtk absorption- of the muscular tissue-. —This is usually the
result of exposure to eold for a length of time.
The affections resulting from simple atrophy may occasionally he relieved by
removing the cause and resorting to measures calculated to restore tone and
vigor to the^ muscles* The most common deformities produced by it are
I* PARALYSIS OF OKE LEG OR ROTH.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment .— 1. Constitutional remedies.
a Strychnia.
L Cold bath.
e. General frictions.
d. Nutritious diet.
e. Exercise in the fresh air. To accomplish this indication we are generally
obliged to use a go-cart.
2 Local measures.
a. Frictions,
h. Galvanism,
e. Acupuncture.
d< Mechanical support.
e. Operation of Stromeyer.
II. FASCIAL PALSY.
Causes.
Muscles involved.
Symptoms.
Diagnosis.
Prognosis ,
Treatment.—I. Constitutional remedies- —the same as those recommended
in the other case.
2. Local treatment
a. Acupuncture*
Moxa over the mastoid process.
£♦ Galvanism.
d. Excision of a portion of the paralyzed cheek. Proposed by DiefFenbach
e - Section of the antagonizing muscles. Also proposed by Dieffenbach.
IIL ATRQPHF OF THE GLUTEI MUSCLES*
#
lo comprehend and to manage properly the deformities resulting from rigid
Atrophy , it will be necessary to consider each one separately. And first of
CLUB FOOT*
Definition.
Vdr%e€$es t —L Tadapes varus, or inversion. 2. Talapes valgus* or eversion.
3. 1 a)apes equinus. 4. lalapes calcaneous. 5. Talapes dorsalis or phalanges3.
Each of these general divisions may be subdivided into three groups, which
1 have termed degrees- for example, we have first, second, and third degrees
of varus, &c.
Causes. — 1 . Congenital; 2. Acquired or accidental*
1st. Or go ngenital , Varlo us theorles en te rta i n ed, T he mos t ratio na 1 is tha l
now generally adopted, that unequal or irregular contraction of the muscles, by
which their tendons and fascia are shortened, atrophied, and rendered more
dense, is the proximate cause of the defect. In some cases, the extensors, in
others the ilexors are in fault, sometimes only one, sometimes several muscles
are involved.—(Refer to some of The most ingenious theories on this subject)
2d. Or acquired* Sprains, luxations, fractures, preternatural laxity of the
ligaments, partial or complete paralysis of one set of muscles, their antagonists
retaining their natural power and vigor, convulsions, habit of using certain
muscles more than others, &c.
Foot most liable* —-The right.
Sea most liable .— The male.
Variety most common .— 1st, or varus.
Characteristics of each variety , and those of its various degrees.
Condition of legs'and knees.
Dissection —The appearances, of course, depend on the variety of the defect,
its degree, cause, age, and the mode of life of the patient. Call attention to
the bursse, exostosis, anchylosis, and abrasions, often met with in cases of long
standing.
Diagnosis -Talapes equimis I have known mistaken for certain forms of
contracted hip and knee.
Prognosis .—Depends on the degree of contraction t the variety of the defect ■
the condition of the bones } the age of the patient, the character of the cause^ the
complication of the case, and the disposition of the patient to submit to oar
remedies.
Causes.
Diagnosis .
Prognosis,
Treatment.
( 85 )
Treatment. 1 . Prophylactic. 2. Treatment after the defect is fully established.
It is rarely possible for us to employ the first, or remove causes operating even
after birth. Under the second head several indications present themselves.
These are, 1. The application of such mechanical measures as shall'* bring
the shortened muscles, tendons and fascia, to their proper position.
2. Where mechanical contrivances alone, and unassisted, fail to accomplish
the first indication, we may next resort to the knife , aided by mechanical
measures.
3. The third indication refers to the retention of the foot in its proper posi¬
tion, after the tendons, &c., have been elongated.
4. The fourth, to the application of such measures as shall give tone to the
weakened muscles, and prevent the recurrence of spasms, or irregular contrac¬
tions which would cause a relapse.
5. The fifth, to the preparation of the patient for treatment. Keeping those
indications in view, which obtain in the treatment of all the deformities result¬
ing from this cause, we shall next speak of the plan of treatment best suited to
each variety of the defect, as it presents itself at different ages; but before so
doing it will be well to explain the character of certain operations, to which 1
must refer in the management of the most of these cases. These are
MYOTOMY, TENOTOMY, AND APONEUROTOMY.
The history of these operations.
Their importance.
Their relative merits contrasted with mechanical treatment alone.
The manner in which muscles and tendons are united after these wounds.
The dangers of these operations.
The question of immediate separation of the divided organs discussed.
Manner in which the operation should be performed.
We are now prepared to take up the special treatment, and first of
CONGENITAL VARUS.
1. Congenital varus, 1st, 2d, or 3d degree at birth.
“ 2d or £th year.
“ 6th, or any subsequent age.
2d, or 3d degree at birth.
“ 2d or 4th year.
“ 6th, or any subsequent age.
3. Talapes equinus, 1st, 2d, or 3d degree at birth.
“ 2d or 4th year.
“ 6th, or any subsequent age.
t, 2d, or 3d degree at birth.
“ 2d or 4th year^
“ 6th, or any subsequent age.
5. Talapes dorsalis, 1st, 2d, or 3d degree at birth.
“ 2d or 4th year.
“ 6th, or any subsequent age.
2. Congenital valgus, 1st
4. Talapes calcaneous, Is
CONTRACTED KNEE*
Varieties.
Muscles and tendons involved in each ,
Causes of contractto n, —1. Conge n ita I. 2 . Ac qu 1 red.
Diagnosis.—. May be confounded with the different varieties of anchylosis
dependent on other causes. ' J
’ Prognosis*
Effects on the joint if neglected.
Treatment.—1. By mechanical means alone. 2. By section of the tendons
followed by the use of mechanical measures.
Condition of the joints after contraction is overcome, mid the treatment n
quirt d in this ftage.
Bangers to be apprehended during the treatment of the case.
CONTRACTED THICH.
Varieties.
Muscles and tendons involved.
Causes of contraction—!. Congenital, 2. Acquired.
Diagnosis —Often confounded with coxalgia when the flexors are involved
Prognosis,
Effects on the joint if neglected.
Treatment -1. By mechanical means alone. 2. By myotomy, followed by
mechanical measures.
Condition of the joint after contraction is overcome, and the treatment re-
quired at this time.
Dangers to be apprehended during the treatment of the case.
CONTRACTION OP THE FINGERS AND TOES.
Varieties.
Muscles and tendons involved in each.
Causes of contraction, —*1. Congenital. 2. Acquired,
Diagnosis —May be mistaken for contraction of the fascia pslmaris or
plan tans, when the flexors are in fault.
Prognosis —Depends on the cause and the degree of lesion sustained by the
tendons.
Treatment. Depends ver y much on the cause * t and we may require mecha-
tucal means as well as the knife for the relief of the difficulty.
contraction of the wrist*
Varieties,
Muscles and tendons in fault in each*
Causes of contraction,~l. Congenital* 2. Acquired.
Diagnosis.
Progmssis —Unfavorable generally.
Treatment —The same general treatment applicable to the other cases of
contraction, will answer here.
( 87 )
CONTRACTION OP THE ELBOW JOINT.
Varieties.
Muscles and tendon# in fault in each.
Causes of contraction. — 1 . Congenital. 2. Acquired.
Diagnosis. *
Prognosis.
Treatment* -—The same general treatment is to be observed here as in the
other forms of contraction.
CONTRACTION OF THE SHOULDER,
Varieties .
Muscles and tendons in fault in each.
Causes of contraction. — 1 , Congenital. 2, Acquired.
Diagnosis.
Prognosis-
Treatment ,—The same as above,
CONTRACTION OF THE LOWER JAW,
Varieties. 4
Muscles a?id tendons in fault.
Causes of contraction, — 1 , Congenital. 2 . Acquired,
Diagnosis . — Not to be confounded with adhesions, contractions from burns,
or cicatrices.
Prognosis.
Treatment - In almost every case of this defect it 18 necessary to divide the
muscles before the different means usually employed can be used with any
effect, (See the cases of Mott, Fergusson, Srnythe and myself)
TORTICOLLIS.
tSyn0ny7n.es . — Caput opstipum ; wry neck.
Definition.^ An involuntary and fixed inclination of the head towards one
of the shoulders. It is sometimes intermittent.
Symptoms.
Causes. — 1. Congenital. 2, Acquired,
First, or congenital.
a. Muscle or muscles on one side £00 short.
b. Paralysis of one set of muscles.
Second or acquired.
a. Hemiplegia.
h. Chronic rheumatism,
c. Fevers of long standing.
d . Chronic myositis,
e. Mechanical injuries,
f. Habit.
g. Palsy of extensors of the neck*
Muscles in fault. — Generally the sterno-cleido-mastoid, but the trapezius,
platysma myoid, and, in short, the whole set of muscles on one side may be
involved* It is supposed by some to be dependent occasionally on shortening
of the integuments or fascia of the neck, but I have never met with an example.
( 88 )
Diagnosis. —May be confounded with recent palsy of the muscles, from
blows upon the neck; with acute rheumatism; abscess in the neck; caries of
the bones ; tumors ; old luxations; hydrocele of the neck, and curved spine.
Prognosis .—Depends on a variety of circumstances. State them.
Dissection. #
Treatment -Depends on the cause , parts involved , and the duration of the
disease. Mechanical measures of various kinds, the knife, and constitutional
treatment may all be required.
STRABISMUS.
Definition.
Muscles , tendo?is , and fascia in fault .
Varieties — 1 . Convergent. 2. Divergent. 3. Upward squint. 4. Down¬
ward squint.
The first is most frequent, in consequence of the internal rectus being
stronger than the external , from its insertion being nearer the cornea, and from
the natural habit we have of looking inwards more than outwards.
Symptoms.
Degree.
Duration —Occasional or permanent. It is also, in some cases, volun¬
tary.
Eye generally attacked. —According to some, the right ; according to others,
the left . Both are often involved.
Mode of ascertaining which eye is diseased .
Effect on vision.
Causes. — 1 . Congenital. 2. Acquired. 3. Direct. 4. Indirect.
Diagnosis.
Prognosis.
Dissection.
Treatment. —Several indications. 1. Remove the cause. 2. Use mechanical
means to correct the deformity. 3. Where these fail, resort to an operation.
History of this operation .
Cases to which it is applicable .
Mode of performing it.
Treatment after the operation.
Dangers of the operation.
Change in the muscular attachments.
Results of the operation - 1. Favorable. 2. Unfavorable.
First, or favorable.
a. Disappearance of deformity.
b. Improvement in vision.
Second, or unfavorable_
a. Operation fails to correct the deformity. Why ?
b. The eye is everted.
c. The eye projects.
d. A relapse takes place.
Methods proposed to overcome these difficulties.
Appreciation of the operation .
)•
' *
■
■
*
■
-
■
/V 4 i - H-'-J^OtOrwu
- • 4 '^ f>~? /ttf 4 & j. m
^ f& *’ ■ ' && 0 &sf“jy>jd''
fo]s /l**t t fcj wt/fa a~n~fr) &*~2-+*q
/&£**> esjhrO /‘^■C of*,}
ftU f/rC*~ to
feC*-* Ch'6 /frn-J-t- c) 4*
— t£. J* a«-J /Co>. Co - A*' V-&00, $0
a4 ?V-4^ )/(>x^'c a 6o S&nyJz 2c£..
tfdrjictA/2 1>4-#'- 0in<^L —
/ftU/lCstiK 7 ' / 4^7 V
/his^iU. - ^ a/c f c <0*3 q
^ <£ £ z ^-t) (b ct-X) ~1~t fro *+S) ifa <£t
va
• V fvj) J 9 forCsh Xs'iwvL
*£Ct± ( ^jLu tc< ij aL *6-
r*- ^T* \* ( V A r7‘ *~J5 d~7J lu^.
±~4rty CXfW-X“ h~y 7 '
C - frd 2i- (2*- 'lr»i*^- —■■ pA*- •
(hrYMj^) f&uiyb/
*HA; . t'vU-CM^ k M/* ♦
j4 f '• • U
l‘ 1 * \ ^
I/Va^ vaW< :> IjAtW
ifiC* ^ f-! ) *vvtAvJ^w uXix- K- h/r
\ f^rjAifyUuJr/lcJ/ h^ *
B^ , ", f* *•- ^SCZZ-MM- KuJ*L (C
SWtaae'?***-»•<**
&Ak v, £<ui-o oW, ^ y - "
_ vn^i t/ ■I't^M 1 t-*/ <r l ^* I ,,. ,'
im& ^uAf A-r '-' ^ 1 —'
—' fshi/'ru
,Xi.ee Xe^h-vdo ^p 1 ' (HAUhsCx*' l~> > ^
k
( 89 )‘
LEUCITAS,
Definition.
Muscles in fault.
Varieties,
Symptoms*
Causes.
Diagnosis.
Prognosis*
Dissection.
Treatment.
camsDJf^ f ° r ? of atro P Il >' 15 exceedingly rare, hut when it occurs, it will of,
attached 6 The dr °? of funet [ on in th f P art . or »'P» to which the muscie is
those nccan' ji* °™ lt,es to gives rise do not differ essentially from
those occasioned by simple atrophy. (See Mayo.)
IX. SPASM OF THE MUSCLES.
Spasmodic affections of the muscles are exceedingly common, and referable
m most cases, to primary irritation of the nerves of the part; but the disease
may origmate m the muscle, and gradually extend to the nerves. It is highly
important, in forming our diagnosis, to distinguish the true cause, as the treat-
ment chiefly turns upon this point. The permanent defects, resulting from this
condrt^mf the muscles, most frequently met with, are certain lands of stem-
paralysis ‘ ms ,tle muscles of the face, scrivener’s spasm, rigid atrophy, anti
I* STAMMERING*
Definition.
Varieties. — l. Functional. 2. Organic.
Causes of functional — Sometimes inappreciable; spasm of muscles, bad
habit from imitation*
Cause, of organic—The tongue may he too large, too long, tied, or badly
shaped, The fauces and roof of the mouth may also, when deformed, occasion
a stammer.
Diagnosis*
Prognosis*
Treatment — Various methods have been introduced, but of course the cha¬
racter 01 the cause will modify the treatment. There are four plans chiefly in
vogue. 1. r ocal gymnastics. 2, Speaking with some hard substance between
the teeth. 3, Acupuncture, 4. An operation.
History of these operations.
Different modes of operating described.
Appreciations of these operations t
Varieties.
Causes*
Diagnosis
Prognosis.
Treatment*
II* TWITCHING OP THE MUSCLES OF THE FACE.
{ 90 )
in- scrivbneb’s spasm.
Definition.
Cause <t
Symptom#.
Diagnosis,
Prognosis,
Treatment.
X. ENTGZOOA.
The muscles frequently become the habitations of parasitic animals, and
especially of the Cysticerens cdlulosa, and the Trichina spiralis, first described,
I believe, by Mr. Owen, of London.
XL MALIGNANT DISEASES.
The muscles, like all the other tissues, are liable to be attacked by tfo
various affections to which the term malignant has been assigned.
VIL DISEASES OF THE ARTERIES.
I. WOUNDS.
Varieties *—Eenet rating, non-penetrating, punctured, incised, contused, lace¬
rated, &c.
Symptoms .—Depend on the nature of the wound, and the size of the vessel.
Prognosis .—Depends on character of the wound, size of the vessels, and the
diathesis of the patient.
Diagnosis .—May be confounded with wounds of veins.
_Etfs?ffr,?.™The hemorrhage may cause death, unless arrested by the surgeon,
or by an effort of nature; the wound may close, and the circulation continue
in the limb, as before ; or the circulation may be so much impaired as to occa¬
sion gangrene ; and finally, aneurisms of different kinds may be developed.
Mode of healing .— Taries with the kind of wound.
Treatment .—See incised wounds.
II. ARTERITIS.
Definition.
Comparatively rare .
Varieties —-1, Subacute. 2. Acute. 3. Chronic.
Causes*
Symptoms of each variety.
Diagnosis*
Prognosis*
Dissection*
Products ,
Treatment*
*H4i
<* *t $i*v*s? S!: :('<* ■' C t/f Jv*?1u>
jfaZiZ hf w /". i ^ uZ^e^o6
^(««U^»vv /i'VfvH. 6-/r^Z fa>
/w ^u. «?r
t *
^ ^Si/i v (/>U ^
**w /fe"i * * i- £* f / ; <^
#/") ft U* &m£i~
.^x-^x e2**y &r^C &ftet2 ~~~- c t &Z* yft**~*^ w / •'*■' *^ ^
x/4wc+ZZ^ - *#-*v V>Lrt«< ^ ^ t ^ ?'■ * huj\
(yi4 tn\c*-y cr^yl [u 0 (m> - f^x^C ex C^^u*\ -v Z^fJul
•* <HA'~i+*'fc ivy 4 $V»4 4' fod+di) i y Mu,
/%ri(4*'Vts^n~ &MtM- jJ^kr ct>H4, (j ''Pffai*
pKi &£ry$ f c tKcx ^* , ^ 1 4-*-^
Jr VioJL _ ftvusy^ I
1-3 S\ It-pTc* h yZi JZ.4, #* £^Z) i
fiF] Us ^V^ 4" W't') ^ CO-<J> £TC->'.t « *,
./^ jts-rjt-.txi fa* etefab^+y t-L^x ^eJ S^yf^/i' 4-J)
Qc^Cic- x v\*Z> ' i > /Lt-Z v £ j i-\&‘*i t~e?c i ( jL ^ ~*
4^ .^u,/ ill*- hi ZLf'-fy <,' ^ /u VC-*-'*—<•' l-%Zx> l
i»4r <35*-e- fA S'■ •■■tx •i )‘t. e L 'J Ss^k-'A i
-J /2- <i^--«. *4? /S» <1 . t- £ ’ — Zf^ASh**-
.
/All
2
a4? />C
£<? ’fifcfantryv S~7+>'l~
A — &■
/^Z £k*Pr ~i gS» jyfZ P Jh 'f i
r-^L & &%r- w jr ^ ^ ^ ^ ■
/<0 * o&4^*£ '1^, &#&£[ Ji” u
/v p 5 ^ 1
fh&yp (Ltn.^j ^
th^ Ct 2^ p(xt\{ f [M p
/l« AY#^ /^Wv <
f-r ^
i. l'lv4
Ls\/s\
h:< !v?
r.i /no
( 91 )
III. degeneration of tissues.
^* e at * er * es undergo a variety of pathological changes termed « degenera-
\twns” the causes of which are often obscure, but usually may be referred to
<4he pre-existence of inflammation. The moat common of these degenerations
are: 1. Cartilaginous or osseous deposited between the lining membrane and
the proper tissue of the vessel. 2. Thickening of the lining membrane* 3,
Atheromatous deposites in different portions of the vessel* 4* Stcatomatous
deposites. 5* Ulceration, 6* Softening*
Diseases produced by these changes.—^ L Dilatation; 2* Hypertrophy with
dilatation ; 3* Contractions ; 4* Rupture; 5* Obliteration; 6* Aneurism*
DILATATION*
Parts of the vessel usually involved.
Vessels most liable to be affected ,
Effect on the shape and size of the vessel *
Symptoms by which it may he recognized.
Diagnosis .
Prognosis .
Treatment *
hypertrophy with dilatation*
l his condition is seen in the uterine arteries during utero gestation, in aneu-
lismal varix, and in aneurism by anastomosis or vascular naevi.
CONTRACTION.
A diminution in the capacity of an artery has been observed by Morgagni,
Desault, Laennec, Mayo, Elliottson, Baillie, and others. The defect is usually
met with in the larger vessels*
rupture.
This is the result of some mechanical cause operating upon a vessel weak*
ened by some of the different forms of degeneration* Its occurrence may result
in the death of the individual, or the establishment of an aneurism.
ORLITE RATION.
A variety of causes may produce obliteration, but inflammation may be com
Sldered the most common* The results of this condition of a large artery, are
gangrem t paralysis^ and sometimes death.
IV* ANEURISM*
Definition.
Varieties. —1. Spontaneous* 2, Traumatic* 3. Internal* 4* External* 5*
Tnie ; 6* False* 7* Mixed, 8* Circumscribed* 9. Diffused* 10. Dissecting*
11* "Varicose* 12* Aneurisms! varix* 13. Aneurism by Anastomosis.
BresckePs classification.—1. Sacciform. 2* Fusiform* 3. Cylindroid* 4*
Varix like*
Number Vanes in different individuals* Usually but one* May have
several, as in the cases of Pelletan and Cloquet*
Causes —1, Predisposing* 2* Accidental, or proximate.
( 92 )
First, or predisposing:
a. Disease of the coats of the vessel. (See degenerations.)
h. Sex. Male most liable.
c. Age. Old persons most liable.
d . Location of vessel. Vessels of the lower limb most liable.
e* Vocation. Laboring classes most liable,
/, Size of the artery. Large more frequently affected than the small*
Second or accidental.
a* Some violent exertion,
b* Wounds.
c. Ulceration of the coats of vessel.
Symptoms .—1. Constitutional. 2. Local. Both classes modified by the
location, variety, size, and duration of the tumour.
Diagnosis *—The diagnosis Is not difficult in the early stages of the complaint.
As the tumour becomes solid it is more uncertain. An aneurism has been eon*
founded with an abscess, tumours of different kinds situated near large arteries,
dilatation of Arteries* and diseases of different organs.
Prognosis* — Influenced by circumstances. It is* under all circumstances,
however, to be considered a most formidable disease—usually requiring an
operation for its relief, although nature is occasionally competent to the task of
“ spontaneous cure,’’
Progress of the disease . — Great diversity in this respect. Sometimes it runs
its course rapidly ; and again* years may elapse before a fatal result takes place,
Pijf$ct§ of an aneurism on surrounding structures,
State of the blood in the aneurismal sac*
Changes which take place in the sac as the disease advances .
Terminations of the disease*
a . Spontsnous cure,
b . Death from hemorrhage,
c . Death from exhaustion.
d* Death from direct influence of the tumour upon some vital organ, as the
brain* &c.
Processes by which a spontaneous cure is accomplished*
a. Obliteration of the sac by concrete fibrine,
b. Obliteration of both sac and artery by fibrine.
c. Pressure on the trunk of the vessel by the tumour itself,
d. Inflammation* suppuration* and sloughing of the sac, and a portion of the
artery.
e. Bursting of the sac* the effusion of blood under the adjacent tissues, and
the subsequent coagulation of this blood* which, pressing upon the artery* causes
its obliteration.
Treatment .-—The indication in the treatment of every ease of aneurism of
the usual kind, is to cause an obliteration of the artery involved* To carry this
indication into effect* two general modes of management have been introduced ;—
1. The first has for its object the dimi?iutio?i of the force of circulation, so that
the blood may coagulate in the tumour, and the artery contract, 2. In the
second we attempt a complete ar re station of the circulation through the part*
by the obliteration of the vessel by some mechanical measure or surgica
operation „
f^ c Sc*
fa-
/**7
*o far*
•X
* JiZc
ri*n >—
^Zuser li ZKZ 7„
et-w.^'fU
Cep z2 +~^/^wWw
if )UjLt/u^i. O'
t-i
3
^p^6X<J
r> u^>~
l*-4 .—— /^*}d /Wi^ *v-
^ Wl^-^ -< ‘^^V- ^£) ^ ^J_t, ,,h &bx4^iu
^yj/i) 4vr P'?^\ , Ho tT\ 'tu\A^Ar'^ W \>&^JhS Uu- f
t (^r^^t^X, }^aW- [yt-^i- pyJL i>'-<~\r \ ^
_ ^H^AvC^ /vv^o. A<m^c> K^WV^-C- (U^-Ui A
V (y^ciL /Uc^u^ ttvL fvxUu tXvn-v #\^ A ^ ^ b)A<(^
■ dxMiA^. -v. (A^tv & Avx^a) < Cy/ x ^V>iW>U< i’Wf^y
I ^Y'Cy pCi CtAVUW^^'S IA CfvAX* i O-i-^A * n
^#C*~C/ Ur C-3 - £4/tbA</1 vVt^Vi!L l^U\yO &*Jt)
“ f^^y- /Qir&ps - <3t- P A
■d/s'tu, __ /"- «A-y rn.'btt* Cy^0/'» t .<) / ' C-'O-^t* ! ^*+{L
*v^ A^() * /£- ^ £.< , " :,•'»' J vtu
w ^ \yt~C- *T&Y^ 1 < ’.'|!'< ; , <?
^ 4 /3t . /.^ _ . *' 7 ^ f > /
H ^ / L
I frx+^i- fcu PCS' * lA prC'k-W^ < & C W'^ „>:> ; .
Idw - >- ./* c^<L» t <'*'< w
HI (K-t/ tixxXvT'.i Lfc^^ t. e ' ^\<j(U-A-1 l h _rf-Av ,.
■* - „ 7-_ * £ cS>
yy-CJ -Jl.^i'£- t - *^> ‘ -—
/kt\gt <x~lp cha-vt
yfa' ^K^tnV ^y tl >vH' Vv/ i r !^L- >\'ZisCxJr &Cl\-'Zl/)
CU'yvl'h,l''lti\*&t a* *j v - -^s ; , ,.,y|^-/> —.
<h c 'C&£' ,>!\6v^ |->\v£^.-v tx - ^>-v\^V4vt ^Uvi) *Cr-
jAxd^tj(<W t"\vv-^U^ jo " fTTU^ Ors^4
/r^ V f
|)^WV
/^ 5</ ' v t^ ^ /'VU^t: ^ ^ rwtr'- ^ A t\/^- (yL^i^-i $ c ^. -
i jpr^C^
ri r>v jf^> Ka »^—
S &pt
11 V*
* G£ a '
Ft%€ £hZ^X^
I cxMZj ■
-h
> Hjt C
:k7,
/$**£&*-tl-t- t
/Fh..<z
\/s£* . '&4C+U fti. {ht-- /- I^t~
. ■'• ’' - r k» ^"9 rt * ‘ ^ >*-V C^i-sS*-^
&&
I i f t / #•► ** / y / V t /-££ ^ ^rj
II ^ *" }4.£^ y 4fi^">^-^'t*-v^ //■,
^ ^rwt? Wf j
| CL-^ ki r^ f ^U ^>»r4 &Q*+r**~^2 L^J
jp*^„ v^"» v.' ^‘4- ^ **»#«?*. <^ -<£> i^v£- ^&**£4*CLfa*+-
»/*/*>>; <4 A*-*]?**#* ^c> gtjv'rr ^ *.Wk*c.*n~
I <t&t«* <■-"*- sfO $t^.M- pjjr***£* //Tr^u-J. '£» ( JSfSj'
| f'*'.,.J /*Wf.t^/t M’t<»-f.' £* jfj f tl*. &. ^ 4 «-< #• AUt^
| ■' >"**S ^ #' r» * £.5 ^ I* /■»<#, <5 j:- | ft-'l-^,<<» yr'/ 7 ^ipM-t
IU 1 - f** 4 ^ — & jd £. 1^ ^ „ u P 7^
ji 7^ ddtTfiP 6^ 6*»- ^ d* ped+Cs $U tUv 'P
III ,/^ -r Av ■ v6? yjjf «.^ «*- *{•,/,>» /~dd^<^r //t *_*.. -. -
fX V- f' V 4 > "V ( ^'<.y>. sj *“ f%& ’% ^iar ^
j iS GCfZ*r^tv£ct«t tr W ^ i *''j& ^ ^
r ^ frJ**?*. ' ^ h cU^s td-dd . A
, ^a Aw ^ ik ^ P$££te£* 4^^'^ ^ /^t,v^ ,jt '^
V- - |4 / y > &-*L C tC+J*-1 * * <4 , ,J t f t^ /l / t ± ^ ^
I I dCi-'} ^ rZv ^4bLd ^ g} ^ _<r "
Atv Ci-*i+c,fi. hit J/& ^
jp f K ^t!t \. /;:; &&isr\,-
J ^ £&** at~£fi i * ^ ^ v^u<^e
''I t ^ /t*X*i.+- /ir ^ ^
^ d^^K' - k r K^vwvytx^i .''VVVHD
pl^vwr C 1 — j*w ryv^4j
to
k
pw»
t^ v , yL i i
ftv
3c) K c
I k^^vvl vV\
(Vv^o^
ki
iri4xsCcZ-±-c-~~ V fy>$ ^
^{ tU *] fansJ ***f<+4*4*** \
/J/T? 1 ^ 1l 'p^ : c c \- efic &*d/cje^, - (fi eLt+hz yj fi—
lrfji+44' fij' «£Ux<, (yi <h+m\t&\+4 fife, **£) /'Cyk'fiuP'
(/~}'<-'6i^-- ?lsLi4*s& />\ fi&~ “/fi fit/Ct*- t-t
/{- PUlhh J //. fifiCv £Lm t,i O^ZZ^ *y Xt^v^ "^l**^* /fit
y? sJfeU' fi (fifi) fili j/ j/Cu+t^O A+*y» fit d***^
v*"^ /L*w /£^«. 3^> ^ *3 y /r*-P
fiTnX' y*-fii.T<- cx *-&" Ct^Jfi) At,^ # 4 ) /Jctjb - 4 t(J *ytj
h^tfij /cfi />~~- yJ^tx/Z 4-^C jt^ fi) L. f ^ 'tfe-iD /LxL
m&fa£Z»l'* ter*/} fiL^U^/x
(A ^€- 0 ^ &/ +*• '<Sj isL &> b,
9 +L+* y S^p^/ZZdUi^ fanlr i-lu t) uit&x*
jf^Uc euSe> * /“ ^
c/v-cx*/- ^4^.2^ ^ Uuvv^r &*/C2> /en
! Zfifi/fiTh ^ iA-Ci'yt^d/.-i^, £*<■'*- *!-*, v AJZr-fit t .- zC- /^<>
i cT/^s m J>y( 1^, ^Cc. t c^/cZt^ ^
(Avu^^c^txX ~* J^puLtcfi (h'U&.J.U tc<j _ <^>? u 'Ififo
&Q sj *Ci* ^
a- -fin ltSt?£ ( » fit ^ ^ .SL .
/fe3~cfi y lc*c.-3 *t- /^Z £**>
^vfr ia ^-out ^ ^ a^P &£v*-f Z*^*-p fr /u/VLy i
jU*”' -faux )l£tu~ - (fiu fefeJfiA*. iUififi
cA^ efic) alCZ'^fi^i tt>> u. I>n t+4 u iv fif^c ci tfi £t+uUt.t t fa
Cilli^^fi tUfiCfi/* — b Cbv-UtAJ^tw U C&w^f>t t-fe tx >—’
/file efi) J^&PUtAl^^ j> *-J- tit C P c?'
jZ'ifitfi *i*>**(t effdL ;** *JlJi.-<sfet** •SU-i-j r . t.-) f*jx*
/Pt^ fix /7> x~- fit-fifUS fi ^ fil l -C- C^/l\ fifi'. {f~Ct t t/fi —-
Ct/thl'Ct-+ fi'i-ts c) ~Z*~f. Zsfitfe. /fitJ Z * 1 P 4 ,. t, c? /fit -1
itfi/ny/c #i.tj JiCt/Zefi/^- £fit*.\, Z <-<3 v U*4^cx >
$*&+ /hr^f^-y^ L/C^v '&£ ■ * f Q fi
pfi/fi <Xfil The J Ay <i~Z (fit. , 4- jO'ficX.
fit. c* /fity~ /fi tst<fix) fit^y 1 t,y 1 st'i-fA
CLcAj
tfiy t>J. .
* ly ’-^i'Z A; J(p^ jj CiAt% ^^ jit
l~* T
/ ^
/0tZT —
/vi^v (*4^"
x <^V=V ^
^ flZZCj
- - - ^ ^ / "— u '
/tr,
! r*-
| ^ <2 l * /j
I &-r** — ^ &%*■*■ A«-i? /*•»- /*-w
^ *' *^r 4^iv^ y?^ A+^r
|! />v & 00 +1++, X ^4^
I J* [ /^Vt-y /* / Z~w —■*—'
I *A? ^ ^
jl ^4wr s$>* *> Xv* 4S« +*/?£,+*rt >
I A^iV ■—. ^>>t/> v ■ 7^-u^a fhx,yik\
\&J h&Z* ^ A & 1*4^ CStSh^bir l-M^s
ki'itj.-l jh*) ivu** '-' & A# ^fcw-k
|V«4 ~rt Janir-'tM'xA fci s'! *Uw
;H^'- V> v'SQ-'t ’) ffy /to k<2-Vlr. i-ty" ^ Av**~\r i^J
I ~^i ‘Hv'*> i-' ja? yv^\A?'t£/ tW'C l
I ^Wtw £i /v(,4 i&£*-t\i^X- ftZju tiA \ '>\^. y* •$-£<* /pCel^L /W^
I J : ' * 4 '* /“ . i£-£^~ £sb---<— ^v&-ts/-i*-pisO /ItscA*. //. i
I ■£c* t‘S~ Ll/^i-Zc- . ’ " £,' ffiiir-;}i i- -\\-\ Y~0
/'^* vt iVt.P (/***? fjdL.4 k 0 Uum
||/)w>£^ £&, o^-^atc ttVh^y ^ Jfc
1 #0 L**^ t*tl } Uttu jjct^ tvu (z fi^ pu^d
M ldtL Ijt*^ Kx
$fa'U'0u£) fai r i^rru^. \ju\mJj 'Uy
P*M, <• UV^V ^tti h&fu^'r ^-imA~ 't&J-ii, 'Mn (ZZZs
C 93 )
Ftrst, or, as it is called, the method of Valsalva -Agents employed under
tins head—
General remedies.—!. Barely sufficient nourishment to support lire. £. Best
m the horizontal position. 3. Small quantity of fluid in the diet, 4. Digitalis
and the antimonies, 5. Venesection,
Local remedies —1. Leeches, 2, Astringents and refrigerants. 3, Ice, 4
Long seton.
Second method ,—Agents employed under this head—1. Compression. 2, Liga¬
ture of the vessel or vessels. 3. Application of the actual cautery—{employed
by Severinus, Mortteggia, Sir E, Home* and others ] 4, Injecting the sac with
some fluid which produces coagulation of the blood—(proposed by Wardrop.)
5. The introduction of needles, or a seton, into the sac—(Pravaz, Philips, &c.)
6. The use of needles and galvanism at the same time—(Keate and Faraday.)
COMPRESSION,
Mode of applying compression.— Two or three methods—L That of Verrnt , on
the capillary side of the tumour, 2. That of Guatanni along the artery, above
the tumour, and on the tumour itself. 3, General pressure over the whole limb.
Agents employed -Tourniquet, bandage and compress, starch bandages-
plaster of Paris mould, compressor of Dupuytren, compressor of Sunfio, &c. °
Modus opcremdi of compression.
Objections to its employ merit.
Appreciation of the method.
LIGATURE,
Not properly employed until the time of Hunter. Before this period the
operations for the cure of aneurism were rude and dangerous. By some, the sac
was opened, the contents turned out, and compresses or the actual eautery
applied to arrest the hemorrhage. By others, the sac was emptied, and then an
attempt made to tie the bleeding vessels. By others, Aetius, Philogius, Guille*
meau, &c., the artery was tied above and behind the tumour, the latter then
opened, and the vessels tied. The dangers of these measures have induced sur¬
geons to abandon them, and we now choose, when an operation is decided upon,
between three different methods of applying- a ligature. These are_
1. I he operation of Hunter. The ligature is here placed on the cardiac side
ch the tumour, or above the sac.
■2 The operation of Brasdor * The ligature is here applied on the distal side
of the tumour, or between it and the capillaries.
■X The operation of Wardrop . The ligature is here applied to a branch of
the diseased artery on the capillary side of the tumour.
hunter’s operation.
Mode of performing it *
Instruments required.
Cautions to be observed in the application of the ligature.
Immediate effect upon ike tumour when the ligature is properly placed .
Subsequent effect on the tumour.
Immediate effect on the limb.
Subsequent effect on the limb .
Time required for the establishment of anastomosing circulation.
Effect on the general System , and especially the brain.
Dressing the wound.
After treatment of the case ,
( 94 )
BRA SHOE’S OPERATION*
Mode of performing it.
Instrument* required.
Cautions to be observed in the application of the ligature.
Immediate effect upon the tumour,
Subsequent effect.
Immediate effect on the limb ,
S ubsequent effect.
Time required for the establishment of the anastomosing circulation.
Effect on the general system,
Dressing the wound.
After treatment,
WARBROp’s OPERATION*
Mode of performing it.
Instruments required.
Cautions to be observed in the application of the ligature.
Immediate effect on the tumour *
Subsequent effect.
Immediate effect on the limb *
Time required for the establishment of the anastomosing circulation here,
Effects on the general system.
Dressing the wound.
After treatment.
Accidents which may follow the performance of either of these operations :
a. Convulsions*
b. Fever.
c. Secondary hemorrhage,
d. Increase in the size of the tumour.
e. Rupture of the sac*
/* Gangrene of the tumour*
g. Gangrene of the limb,
k. Chronic inflammation and subsequent ulceration of the artery or sac.
i. Plethora,
Peculiar advantages of the different operations discussed,
CAUTERY—INJECTION—NEEDLES—GALVANISM AND ACUPUNCTURE*
These different modes of treatment have recently been introduced into general
practice, and, although one or all may prove more or less useful as adjuvants to
other remedies of more importance, it is hardly probable that any thing moie
than this will ever be claimed for them.
Appreciation of all the various methods of treatment for aneurism .
TRAUMATIC, OR FALSE ANEURISM*
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis *
Dissection,
Treatment ,
BE
( 95 )
Definition.
Causes.
Symptoms *
Diagnosis,
Prognosis.
Dissection,
Treatment,
VARICOSE ANEURISM*
Definition,
Causes.
Symptoms,
Diagnosis,
Prognosis,
Dissection,
Treatment.
ANEURISM AL VAfUX,
Synonymes.
Definition.
Causes,
Symptoms,
Diagnosis,
Prognosis.
Progress .
Dissection*
ANEURISM BY ANASTOMOSIS*
Treatment. —-1. Compression, 2. Ligature of main arterial trunks, 3,
Encircling the tumour by incisions. 4, Seton. 5. Breaking up cells. 6. Puncture,
followed by caustic probe* 7, Puncture, and injection with some stimulating
liquid. $. Vaccination. 9, Caustic potash, 10. Nitric acid 11. Tart- antirm
12, Actual cautery. 13* Incisions under the skin, 14. Acupuncture. 13, Darn¬
ing. 16, Ligature of the whole mass, 17. Excision. IS. Tattooing,
Definition,
Causes,
Symptoms,
Diagnosis.
Prognosis*
Dissection.
Treatment.
OSSEOUS ANEURISM*
V, PARTICULAR ANEURISMS.
The symptoms and treatment of each one described.
( 96 )
VIII. DISEASES OF THE VEINS.
Varieties.
Symptoms.
Diagnosis .
Prognosis.
Results .
Mode of healing.
Treatment .
Catises.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
I. WOUNDS.
II. RUPTURE.
III. INFLAMMATION, OR PHLEBITIS.
Varieties . — 1 . Acute. 2. Chronic.
Causes .— l. Constitutional. 2. Local.
Symptoms .— Vary with the intensity of the attack. They may be divided
into the constitutional and local.
Diagnosis.
Prognosis .
Dissectiori.
Effects resulting from phlebitis — Obliteration of the vein, visceral abscess,
eedema, ulceration of the vessel, calcareous deposites, &c.
Treatme?u .— 1 . Constitutional. 2. Local.
IV. AIR IN VEINS.
Effect produced by the introduction of air into the veins.
The manner in which it gains admission.
The causes of convulsio7i and death in these cases .
Means of preventing its introduction while an operation is going on.
Treatment in the event of its introduction .
V. VARICOSE VEIN.
Nature.
Location.
Extent — The dilation may be uniform or unequal , and involve a portion of>
or the entire vein.
Causes — Anything that will prevent a free circulation of the blood through
the vein.
Symptoms.
Diagnosis.
Prognosis.
Dissectio7i.
Results.
Treatment. —1 . Palliative. 2. Radical.
( 97 )
Agents employed as Palliatives,—Compression with rollers or straps, or
both, or laced stockings, 2. Frictions with iodine ointment, or Davis’s solution
of iodine ; repeated blisters, 3. Galvanism. 4. Puncture of the vein.
Agents employed with a view to a radical cure—1. The ligature. 2, The
needle and ligature, as used by Davat, Velpeau, and others. 3. Caustic paste
which occasions a slough—(recommended by Cartwright, Mayo, &c ) 4, Trans¬
verse subcutaneous incisions, followed by compression—(Brodie.) fn Excision,
followed by compression. 6, Acupuncture, 7. Seton, S Subcutaneous liga¬
ture—(Ricord,) 9, Irregular compression with graduated compresses and a
bandage. 10. Position, rest for several months.
Dangers of these measures.
Appreciation of the different methods,
VL OSSIFICATION,
Causes*
Symptoms*
Diagnosis.
Prognosis*
Treatment*
VII. PHLEBOLITES*
Definition*
Veins in which they are usually found.
Cateses*
Symptoms .
Diagnosis.
Prognosis.
Chemical composition.
Treatment*
VIII. MALIGNANT DISEASES.
The veins are frequently involved in the different malignant diseases which
attack all organized tissues*
IX. DISEASES OF THE LYMPHATICS.
I. WOUNDS.
Varieties*
Symptoms.
Diagnosis*
Prognosis,
Results *
Miode of healing.
Treatment*
II. RUPTURE.
This lesion is stated to have occurred in a patient of GmfforPs, but the symp¬
toms are too obscure to merit our attention, It w-as supposed by Morton to be
one cause of consumption ; by Ackermann, to exist in scrofula; by Hendy to
exist in Earbadoes leg; by White it was considered the cause of phlegmasia
do lens ; by Assalani and others it was reckoned the cause of dropsy ; and Erom-
bilta thought it the cause of white swelling.
( 98 )
III. VARICOSE DILATATION, OR CIRSUS.
A rare and obscure lesion, present usually in dropsy and some other com¬
plaints, As it is an effect ^ it can only be relieved by removing the cause on
which it depends.
IV. OSSIFICATION,
Like the arteries and veins, these vessels are liable to calcareous deposited
in their coats,
V, ANGEIOLEUCITIS, OR INFLAMMATION.
Varieties —- 1 . Acute. 2 . Chronic*
Games,— 1 , Direct 2. Indirect,
Age most liable. —Puberty and old age.
Symptoms. — 1. Local. 3. General.
Diagnosis —-May be confounded with phlebitis, neuritis ^ neuralgia t, erysipe¬
las, and phlegmon.
Prognosis. —It is to be considered generally a dangerous disease.
Progress and duration,— Variable.
Terminations .— Resolution, suppuration, induration, ulceration, sloughing,
death.
Dissection , — Three classes of phenomena to study.
1, Those which take place in the vessels.
2, Those which take place in the interposed tissues.
3* Those which take place in the viscera, remote regions, and blood- —
( Velpeau.)
Treatment ,—1. Constitutional. 2. Local.
VI. INFLAMMATION OF LYMPHATIC GLANDS.
Causes,
j Symftfoms.
Diagnosis,
Prognosis .
Terminations,
Treatment,
VII, ENLARGEMENT AND INDURATION,
Comes,
Symptoms,
Diagnosis.
Prognosis,
Terminations,
Treatment.
VIII. OSSIFICATION,
Usually the result of inflammation, and the glands most liable are those of
the lungs.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Terminations
Treatment.
Varieties,
Symptoms,
Diagnosis.
Prognosis,
Mode of healing,
Treatment,
Causes,
Symptoms.
Diagnosis.
Prognosis,
Treatment,
III- NEURITIS,
Varieties, — 1 . Acute. 2. Chronic.
Causes. —l. Constitutional. 2 Local.
Symptoms ..—Depend upon the nature of the attack.
Diagnosis.
Prognosis ,
Dissection.
Terminations ,—Resolution, effusion of lymph, ulceration, hypertrophy,
atrophy, hardening, softening.
Treatment .
IY. NEURALGIA,
Definition*
Varieties.
Causes.— 1. Those which act upon the nerve itself. 2. Those which ope¬
rate through the system at large.
Parts most liable to he attached.
Diagnosis.
Prognosis *
Pathology ,
Treatment — Indlcations—1, Remove the cause, whether constitutional or
local , 2. Palliate the pain, 3. Divide the nerve. 4. Excise a portion of the
nerve, 5, Acupunctural ion. 6. Electro-magnetism, &c, 7, Moxa, &c.
V, ANOMALOUS NERVOUS AFFECTIONS
These vary in character; and of course the treatment must be based upon the
peculiarity of each.
( 100 )
VI. HYSTERICAL NEURALGIA-
Definition.
Persons most liable.
Parts most liable to be attacked*
Causes*
Symptoms.
Diagnosis.
"Prognosis.
Pathology.
Treatment.
VII. TUMOURS,
Varieties .—Solid, or encysted.
Location, the neuritema ; between the superficial fibres of a nerve, or
they may implicate all the fasciculi at the part attacked; and again, they may
be developed upon the extremity of a divided nerve in the shape of a little but¬
ton. Lastly, they may occupy the large and deeply seated nerves, or the super¬
ficial and cutaneous; when developed in the latter situation, the tumour is called
11 pa infnl s ubcutaneou s tu betels , 55
Causes _Blows upon the part, the application of a ligature, &c.
Symptoms *—Depend upon the location of the tumour. They belong, how¬
ever, to the class of « nervous symptoms, 55 general as well as local.
Diagnosis.
Proglto sis.
Pathology.
Treatment .—1, Palliative. 2. Radical.
. Palliative means—
a. Leeches.
h. Counter irritation.
c. Fomentations.
d. Anodynes,
Radical means—-
a. Division of the nerve above the tumour,
h. Extirpation of the tumour.
c. When the tumour is a eyst^ puncture followed by compression*
Condition of the limb after the removal of a portion of the nerve.
VIIL TETANUS,
Definition.
Varieties as to muscles afected. —1, Opisthotonos* 2, Emprosthotonos, 3,
Pleurosthotonos. 4. Trismus, or locked jaw.
Varieties as to cause mid duration,— ]_. Traumatic. 2. Idiopathic. 3* Acute,
v, 4- Chronic.
Gems$s.~ 1, Constitutional. 2. Local.
Symptoms —Vary with the location as well as the intensity of the attack.
General symptoms stated.
Diagnosis.
Prognosis.
Pathology.
Treatment —- 1 . General. 2 Local.
( 101 )
IX. PARALYSIS.
Definition*
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Pathology.
Treatment.
X. OTHER ORGANIC LESIONS.
The nerves, like the other tissues, are liable to hypertrophy, atrophy, harden¬
ing, softening, ulceration, and malignant diseases of various kinds. But these
lesions are rarely recognized until after death, or they give rise to the pheno*
mena already referred to as characteristic of diseases to which specific names
have been assigned.
XI. DISEASES OF THE CELLULAR TISSUE.
I. SIMPLE INFLAMMATION.
See “ Inflammation. 15
IL PHLEGMON, OR CIRCUMSCRIBED INFLAMMATION.
See Phlegmon.”
III. ERYSIPELATOUS INFLAMMATION.
See “Erysipelas.”
IV. CARBUNCLE*
See “ Charbon or Carbuncle.”
V, ABSCESS.
See ** Abscess.”
VI, HEMORRHAGE.
Causes .— Mechanical injuries, and diseases of a peculiar character, as pur¬
pura, scorbutus, typhus, &c.
Character of the blood.
Prognosis.
Diagnosis,
Treatment.
V1L SEROUS EFFUSION.
Synonym.- — (Edema, anasarca, aqua mtercus, leucophlegmasia, &c.
Causes.
Symptoms *
Prognosis.
Diagnosis.
Different kinds of serum effused.
Treatment.
( 102 )
VIII. INDURATION.
SpottyScleroma, skin-bind.
Persons most liable. -Children,
C aus es,
Symptoms;.
Duration *
Prognosis,
Diagnosis,
Character of the tissue.
Treatmetit.
IX. EMPHYSEMA.
Synonym.* —Pneumatosis spontanea et traumatica.
Causes -Mechanical injuries, and sometimes It occurs spontaneously.
Parts of the body most liable to this collection.
Symptoms,
Prognosis*
Diagnosis.
treatment,
X. TUMOURS OF DIFFERENT KINDS.
See * 1 Tumours.”
/
XI. CONDENSATION INTO CYSTS.
Causes.
Indications that they have formed.
Uess of these cysts,
XII. DISEASES OF THE ADIPOSE TISSUE.
I. INFLAMMATION.
See «Inflammation,”
See « Wounds,”
II. WOUNDS.
IIL HEMORRHAGE,
Causes ,
Character of the blood.
Symptoms.
Prognosis,
Diagnosis.
Treatment.
IV. HYPERTROPHY, OR POLYSARCIA.
Varieties -1* Partial. 2, Complete.
Causes.
Prognosis.
Diagnosis.
Dissection.
Treatment.
( 103 )
V. ATROPHY.
Varieties, ’
Causes*
Symptoms *
Prognosis*
Diagnosis,
Treatment*
VI. TUMOURS OF VARIOUS KINDS.
See “Tumours,*’
Diseases of the Skin, Hair, Nails, and Teeth cannot be embraced in a course
so rigidly restricted to the most important points in Surgery ; they will, how¬
ever, be found in my work on Surgery.
THIRD DIVISION, OR DISEASES OF REGIONS
AND ORGANS.
A
("/ -. ■f
/'Y>t j/r
pTr /*.
C't&Cc£,' i J‘ ;y, *J( '2 , -f / f '/
CSl
>~7L-
Jp£/isC>
/£
£>
■^kyy;
i
'l*'
At 4L*&{ •
-A l i
V+ta. t y d«-£V dUl*S/J r
A*?/ UtZsC*^ V- C dj
P
7( L& - 7t f - H p
^i- f~*
/ai
f rtr* "* v ~' •—- ^r * I ^ ^
j, 1&V&*
\ > rfVJ'fc-'tf— f~/l^j? /
/<#r a^/v p-mun- 7<* 7t (m< f &./C/C /& &*~C ■—
7 t'77 f- /} ~ 'Jr^ -
/'k- < ~C (P £ ^ f i^- > ^ i ' l
/tortf-n^iy, &PA-t '
Aft v^c. y /i'tu t^ — A**
,'-ts -c •
/■*-<*■ -tt- d-t*> l
s7f-to/ &C*~~ jd. s't %.,^'C 4<
/ > \ /7& +-*■%■■ ***■ & 77rK* +-y? f ; -7~ *'' u^ ^5 - -
£l fuj€- p * iyj t-j y *T +* t e S%- t H ' /—-
^ pts*--p4 Aik sc- J-
, Jz SI » rj^C>' *njftr J K4 » '■>( *■ £..<£(■ C J Al (y j :>
£&-Afcr Otcs/Z ^ ?'7 - pf''-7<3 /
A^*-6t £*7^ '****7J-*-+s*s7 py~t^ p+P / ^-\ —
^f&C/ ! C' ^*?v\s~ Pts 4 ^ . |
A&trirtr x +%-V 7fvtt*k w p^Jt^yC-
pPuin^C rf Jic Gt+ +**7* r~ ppft*)
Abfp &'tcsf 7'b - COy^Uy _ _"
<T y6 /)l ) i Cr rP*' L. Ootyd
f/i /? ✓ /u #(<. & £l H£i>~ 6<s- /t I i't, fa
J‘2 / X/ cC ,, ^ *(*''&•> /t'/tf/fr S ''
k V' / w^- / t ‘/'i ^-^A- 0
£ T\ c~ . c J* *i*~* p~/'** *
ifas-C feu, fePuPict t^T' 0 $-C -
'feiOn*. 0 %*O A^L-. V ^U-t^ )%&Ur&*\
/is$ ,/pJ ll ^ A ^ ^ i ‘t/£ i/tfe&'fit'l J
0 ^^ fu^d' &£*-40 ^ l
p(/~ff~lAfdl) P/tAyi/jo^y^^i. <&" i (( 4^
wyc, 4*' -
*!■ ^
hcM
^ 'jj & / ^^pt^C'
Oi/yv^£~ A&fsic &/Ct*tsts&C iu^*^di<~i4PA*t/ t £'>>02 t
_ 0~K? /* '(- -?- "< A „ <2-t't'/j/ff'i*-
p^u^yfZ £tL-u* <ro 4 & 4 r‘ Us't'fltt'n^
<fef 0 od/. ' _ ^ *
k<- itw&ism , ,; ‘p _ /?yi*ct**//
/fjh- 6 €^^ 4 t. t t^tPfiC ^H-vK /ifte^^duu
/wPuasc- Aritoi fert^bu Arui
r
p\L'l /t/ty
\ I / > ' ' t f'/
&zt~fe /k « ~ 7 ? (
^Urausui^j fer^^K* ^ 6 r<* ut< ^>^cj
/^>v ^ £ t'\^ 'f 0 Zc / ""* ( //A rf-'^
- ^ -A*Th ^— &#(0 £l i- v4
/t-ZH^j' U) ^f y> ~~' // d.t: . .jPCtS
(x.L.'f jStstAS**^/s dfefo ^/y^ypiMUZ Lipoid
4l' / . , 'V» <?fT' Ly t' 0 ^ !* > (s**i jSt-if r 4/-/“ !■%«■ 4- A ■„ (Li-t**
/t'l'^*' ^^-O--''/ C'^ t^&Cto (\PPPt j Ct i L. ‘t' AuP
0 - ^ t A-^/- • *j^ — . 3 ~~ d ityut/ pc d&y-d'cZt**^
At 4 r -- '*y / / t-1*' ^
{{p't'S'-p ^rtX-tlji^- ■a.L.t.Q dL^PA,t,J ^ i ' f h. td
frm/ -<- /?wvA (rpv^t/ if Pi~-
Cl>if<Pt-liud- Ip.- ^ «ff. lf -u I <. Of
[ ^ :•■) ih'Uf.d j r G--)ff'y — U-'t-vL-'i'-i 1
Ih " tv^y\p. — 17 " u/d^C
fy
(TM \
/V /c Y jx £tr-r &y.t C- /?t \
-/-
\n
$du&t- j
/_
///^ v ^/j>. ’ *11 fa.ft ,/ 4 -
jb+vil^l’L^^ jfr L ^ h
joJ^j^xXly * / ^_
" 3 * hfK&+\* vtx/fi/et n^-n ^
^ 3itt j~
^ 4 * **^“ ^ A-V-< - cjr-lZ.
fit** />V>L L- / £^ 4 ^ /^H/V k
jj <
Afr t^ /n/ ^i^</
/i
4 ^^- vy
a5^.
_^_^ f „ ___ _ ^-’7 A'
fax hldttsf **^7 /;^ L^-u/L/]
L**Uj~ 4 <} > _ 4 A^o t f^U-t /fa- 1 */*■ _, fhiG 2-<—■*
^ S CT>
I Ar>p^J &PV**U
Uwt it t
^ /i^ir £c?Pisy%is~
— 7 ^y 3** 1 Ar&hp ^<r >>«
Z ^ ' ■-&- — y^i^-i s 7 -<- fn <, & 'fcti.yc.
<s-e<.yy ^ / ‘ *''*- */ g ^ - 'i/i $i/h ~y/ijytyy _
/KotJ? <^rv iU ^ 4*-‘-'> (Z^hx~ Qsi/Vuiy- y ^
LZ? jfrUV ft/ £t*> 4 - "7U <? fb-t^
ky t-o^xy /l ^-ot- {yz- fti ^tst l
1 ^ J7>*^ fit-ftl) 11 J
£.ryXr& / J
hrCU ^<J /t+^2 i^^&>^33cs ^ l4x^
\i^u. j£.^j~?h* Uc*~^~ Uyfiyyyy, - A^-ct*^
^ 4 /i*£ -' <-*^ >W V y^/t.
~J 4 k 4 a-±
tsv
A ^tt/<
f
$ 4 ^ 3 ' /Ay~ty^t^
y
- <rt
/(a^ .g'tZ
6 *h
kfU
t*
7
’/J ^3 Uis l L*
Ayy* .y
iv/V
—' L- 14 ^~ (, '£*
lyPdZ*
Y
—- y'yC^y' IjTu pt* *t3)i '}p&
ly^vv j'i ] j' i^,—- 4 i)
( 105 )
V. PUNCTURED WOUNDS-
Causes.
Symptoms.
Prognosis*
Diagnosis.
A. esu Its .
Treatment*
VI. WOUNDS OF TEMPORAL ARTERY.
Causes.
Symptoms*,
'Prognosis.
Diagnosis.
Result $.
b. WOUNDS INVOLVING THE SCALP AND BONES.
I. INCISED, LACERATED, CONTUSED, OR PUNCTURED WOUNDS.
Causes.
Symptoms.
Prognosis.
Diagnosis.
Results*
Treatment.
II. PENETRATING WOUNDS,
Causes.
Symptoms.
Prognosis.
Diagnosis*
Results*
Treatment*
IIL GUN-SHOT WOUNDS-
Causes .
Prognosis.
Diagnosis*
Results*
Treatment*
e* WOUNDS INVOLVING THE BRAIN AND ITS MEMBRANES, ETC.
Varieties,
Causes*
Prognosis*
Diagnosis.
Results .
Treatment*.
( 106 )
ENCEPHALOOELE AN OCCASIONAL PRODUCT^ OF THESE WOUNDS,
Definition.
Symptoms.
Prognosis*
Diagnosis * +
Results ,
Treatment*
IL DISEASES OF THE SCALP, fee. fee,
I, ERYSIPELAS*
See « Erysipelas.”
II, ANTHRAX,
See Anthrax.”
III. TRAUMATIC NEURALGIA,
See « Neuralgia.”
IT. PERICRANITIS.
V* THICKENING OF PERICRANIUM.
VI* TUMOURS OF THE SCALP*
See a Tumours.”
Ill FRACTURES OF THE RONES OF THE HEAD*
Causes*
Varieties.
Parts of the cranium most liable to fracture,
Age most liable.
Symptom# .—Depend on location of fracture, fee.
Prognosis.
Diagnosis *
Mode of union.
Treatment.
IV. CONCUSSION.
Definition.
Extent or degree*
Causes *
Symptoms — Three groups^!, Stunning, 2 . Loss of consciousness, fee.
3. Convulsions, fee.
Prognosis *
Diagnosis .
An atomical examination.
Results*
Treatment,
1
3
**»ffZo Jj C t^Uu^ J-
Ui^-p^c, /U. j^y /),^/.
'fr^wW *to £T Ujx-\,f*-e~ jpnn^ fr&UstcuJr- hAjru^d)
^$uCZy'<* fxUJZt+'U ^ i y tu*d ~Aa H'*t.± -^ gj
h^lc - i V*v Lrx, t t^Ci ' «. ajdUAu) U *
^wfc- -^Cw^lZt- — ^Uy^.JfJU, UMuAl'i by t**-Si
bhtfJLs (^ ^fllu. c<j On ^Xo^O Ah: r
53 r KI^d
^ A-^Cr. ^>UJ^fa4 _ , w , . ....
<?M) tw farry&Jt, - £?&*€*£• t+-e> A-V
dxruAjIc ctc,l^7<-*^-^ * 4i^H '-^a-£j«_ 'Qc_fr?css *) j
^ A ~ nr •'^ -'* * ■• si "‘ * “ A ' * rf?>^ C'*" dj^uv
<* / y-& tfijfL&h&s tfr\J-
' - T ^ ►" — _ fc*—^ 6-rtpr* 4^-VV" ^ IO*
ttZXro UJ ^-ihrtA^-d) Cl**- e)
,. / i , -r , . *
*-£&** ^1V —
0 •
& £<*,
tAv ^
, . ut-A^ ^ ui r *«-^
fuj&A * pj4 a (A <**~^ K^^vv/ _ <hj*JtA4jCL~
(t*v*- !\^//\*-v^~db ^i^ls~ J; Cc L ^uv'^fc-' d-t* i-'"'* /l^)X/t-»|
$s1/j r YT1A^‘^ IMiAs- thsC*jj')-'j*- £.vw <*-■- ^'4- _ '
$■" &U - ftW l * u <SL Qu^lA - A&J&y J jvtf* A-
yuv^uv^ ^ 11v h
d^U,(^uC CY k*-0i£pTmV&t'^./tud AU. '{j/-«-Q KvMt,/ *
^Auu^h fidu /7 W a.J^tx- w 4,-j. eT~T-~ cx«*~ o
far&e~~ f{s*v~C- tvou^-i- yO i- C if-d-^i- ^} ' J
^ >u. ktt Ttr'fl'U ^ e.^/} tsLl
A- / >- t - J 3 ^
£w<-'d>'?'J'+ L <v <Sc—-—<S edu &L a -/.', 4—
4^7
jjh>-^ t-** — a^i.2) ^ 6 ^ s>kw —- L
fol &Y\\s A 1S1.1VW ^
fij /y ^ 1 1 . ^
/-4 A i\/^u of /G r^ ^
A/fi (ry>uv clI\^
\ iA /
/*> J r J-/ *- 8
P^/l t
>tt
/>
pt
ly t tx *^c
ty&Z *4
f-.
/L -
f - /?iV X~/-
/j *l±i * ^O'U^
i/) &*+ yfefc ^7>o^
( - v €, pV^^L J y^<
X /? * a) v
f^y 4 'p i - > fpri*«s4 /
#"i &*^o 4. /,^ ^ 4 —
i jr0^t/2n^ ■ 0 **. {jfay~^r*+i ..*' fi^ffZuts 4^%#^ h'zn viJj
IV 1 < * * .- : i ■* — ~ * f
r&^ i { \,,^J-- %^h ftL^pAiy-U. 4r c£w/lA^
LjL u . t / ilh t /.
* J f/uw & -Uf
Pw /V rl VL i’r. *a, .. w //;: 7 .. . z^f . > v * /■ /
^y. ^ ^ s ^f />fcc>
&& £fa& 9 J? > f/utf y
7y ;/ //- — tJ ?>^0~<i+ 'ir fjf <p:/''}i u ^r~^v
hcflh+vxe, ^ a: // pj^sl A/
[<4^6 Au-v 4^ TtT ’&£&(&**■ Ptr &~o &+t k. /
4*><u Afr>-3~<2J — <7*<r?. CpZc^-L. sjf fa. *
&Ll4^ - — /A_.,__A y_
I a^Ajj A/ Jo&tf* Styfa'i- t_-^/pr~*
If C&-**- / AA - A^/ ihrfifr /iL^ ^ A/flo
A i ‘A ‘ L ftp- A —' t-j A AA*"-7 t-J
■fL*-lt- ff\/\- (£% , i \ __ P/"h/} AA-^t^
>^" 7' J - ^v^X, ^ >u ^ ^ y ^ 4c
^ f^ prr^ &t*St ty /<A>
^ )i '•'hf^/uj-J (Sr — a/ //c»
ttcveMfe l/vyvtcA^a ' ^yuA,
^ o-»t/V
&-Iv(l^ P k-rft' $s+*4
fyguc^.TT^
L
ft/,is'l 11' ^ rt-f ti C C
^ ft &-t<rtrf tfb // $4/h\£* {BisH,d 14 UAtft #7 cJ$
ftft ^cs^o 7w Uw &t & ft St pr U ^
ftst^c &-40Zftu* _ ftj 0uL £.4/t^g*i-d%/ i / t /t ; 7c
Mju^c> *n flu l/ix,
-tyu, tjf i/j fa, fasjfTl^ jf ^ „ flu**. fbA-r Iff
C^c) fc/lf .
t ^/yf^tr-c A fa^c jvCts s^/A& ; /. ’ ^
0 W /.si —- /fit fhzm Jiov vt / ftuTftft £?<+ eft)
foi- ££S jO& ftft/ AAcs ^
fox oX&l Jhfos ft A?y/tssc^ 07 c* r^ / zt t*/ f%**a ‘z+t±
sza p 4t-r< cftfti^c JJhA
ffo &&**+- ch^ftft . Ht ^, / ftCft J w<yS *ft 74, 4
-jir<f? 72 l.£. Stp J ^C-t) 0> c^ A&&*' ft/D^y^ ft>J ) t ~4
y J/i£ nL**£d£*+u *>Y J ft &*- //^j /ftft^A
^ ftvKtj 0..- L//<t^ A A A f~i ^ At* fti+y
A a>iAscfty jZ7i it*t^c^ *Z t t + tup/v /C^ //• / A t
*f 1 *' t *^*^*W ^ t ^ ^ V i ft//v /to* t jT ^ , 7* * * /■•- / / /C/ tir -
£? AJ 'i^p£ t j „ ^ Ay
1 fc0Li77^ £*~i^ A* / : ***Z i# ffarfC p*t P f JS £y /*■* /<* ey S J*
<£ a l 0 rt> 4^yv cy^/► «W~e r<_ ; . , .
m tl <4r * ^ S , &*x^€? * >f t j* ji ^ t /4^ <£V rf.A ^ t_ j^)
*JU<—•
&fKt,r ^Wv*( {tv /Ji P /
&7pi <lA/7i * / y' - ^ „ A /Q?Ur^l — /r- dk,^ C <Z to^ /*
^at^^Ay y ^ a? pub }fSt P i>e- t c L^s/777^^ yv- fyn*
ft fa st 7s cf-c s ft/ i?>'JLs &y
fifdt t dt_& A* J
t* /S^itii pA- i /7 ^ :^Yc u ^
^7 «-/ ^;/ y A-fr~Th> "V -tftvtf
k- y
|| ^ (ft-$ v jft /iv y- £&ut4ft /i^L-A , ^ '. ^ ,1/'
4/,^ .v'/* t.
/
• ; .'c A
u
Sr'/hu}
6*hy /•
.-bit*. lJ __
UriLC'
J?r.
si'i
t&U'Mv.C'd *vds Hstr’i
b
*+*f -H}
' w*'Lc£s - . r
u^c 4 1 , y
^.fosy^fL ^>^1 k > 4 ^ ,fe /-b r ^ **£_
■4 L*'^- IsLn-y i / jtii^ *4 { lyct-isd /%■" b^C*
y 4 '&&{, mji.
U*-C^ C'&tS ^ <? r/ f> ._ / &
: &L / + yL't P^ T)-£gisL yX< ixs^£
\fc if ( / 'Tv&tfi-ti 1^4*44 yyy^-t/^c y -
( 107 )
V. COMPRESSION OF THE BRAIN.
Definition.
Illustration of the influence of pressure upon the brain *
Causes .—Depressed bone, effused blood, collection of pu$ 3 &c*
Symptoms .—Depend on the nature of the cause.
Prognosis .*—Depends on—1. Extent of surface involved. 2. Location of the
compressing body. 3. Location with reference to depth , 4, Nature of com¬
pressing body. 5, Suddenness with which compression is applied.
Diagnosis.
Manner of ascertaining the seat of the injury.
Manner of ascertaining the nature of the compressing body.
Dissection.
Results ♦
Treatment .—Varies with cause.—
ai When the bone is depressed*
b. When effused blood is the cause*
e. When pus constitutes the compressing agent.
trephining*
History of the operation ,
Diseases of the head for which it is employed.
Dangers of the operation.
Parts to be avoided in applying the instrument.
The operation itself described.
Dressing.
After treatment.
Mariner in which the opening is closed.
PARACENTESIS*
INFLAMMATION OF TRAIN,—(See Effusion.”)
II. INJURIES AND DISEASES OF THE SPINE.
Classification*
a*. Injuries and diseases of the spinal column*
b. Injuries and diseases of the spinal marrow and its nerves, 1* Concentric
diseases of the true spinal marrow. 2. Eccentric diseases or those attacking
the incident or excitor nerves. 3. Diseases of the reflex, or motor nerves,
4* Spinal irritation*
( 108 )
a. INJURIES AND DISEASES OF THE SPINAL COLUMN
ITfcELF.
I. FRACTURES.
Liability ,
Causes —-External violence directly or indirectly applied*
Usual seat of fracture, —Spines, bony bridges* and body*
Division — 1 * Those occurring above the fourth cervical. 2* Those occur¬
ring below this point*
Symptoms .^Depend upon the location of the fracture and its extent.
Prognosis *—Depends on location and extent of fracture*
Diagnosis,—. May he confounded with luxation, concussion of spine, com¬
pression from effused blood i inflammation of marrow or its membranes *
dissection.
Treatment.
II. LUXATION*
Id ability.
Causes -External violence.
Yertebrce most liable,— The cervical, especially the second*
Division -1. Partial. 2* Complete,
Symptoms -Depend on seat of injury and its extent.
Prognosis —Depends on the seat and extent of injury*
diagnosis.
dissection.
Treatment,
III. SPONTANEOUS LUXATION OF THE FIRST CERVICAL.
Definition,
Causes,
Symptoms —In 1st, 2d, and 3d stages.
Progress ,
Prognosis.
Diagnosis.
Dissection *
Treatment.
XV. CURVATURE*
Definition.
Varieties. ■ 1 . Lateral, or scoliosis, 2, Posterior* or gibbus or cyphosis. 2.
Anterior, or lard os Is.
Causes —Predisposing and immediate.
Prophylaxis,
Symptoms —Depend on the variety of the defect*
Progtiosis -Depends on the age of the individual, the duration, cause, de¬
gree, and complication of the case.
Diagnosis. —May be confounded with caries f partial paralysis, natural in¬
equality in size of the two halves of the body, &c*
Pathology,
Effects on the spinal column, its contents, and the health of the individual.
Question of marriage ,
Treatment.
( 109 )
V, SHORTENED SPINE,
Definition.
Causes.
Symptoms.
Prognosis.
Diagnosis*
Treatment,
VL CARIES OF SPINE,
Liability -Children most liable ; may occur in adults.
Causes.— l. Constitutional. 2. Local.
Symptoms. —Vary in the 1st, 2d, and 3d stages ; and also depend on the age
of the individual.
Prognosis ■
Diagnosis .
Effects upon the viscera of the thorax and abdomen, and general health of
the patient.
Dissection.
Treatment.
VII. ABSCESS.
Causes.
Symptoms ,
Prognosis.
Diagnosis*
Dissection.
Treatment.
VIII. EXOSTOSTS.
Effects of these mmours on the f unctions of the spine , and those of the adja*
cent viscera.
IX. ANCHYLOSIS.
Effects of this condition of the joints upon the functions of the column*
X. SPINA BIFIDA.
Definition.
Causes.
Symptoms.
Prognosis*
Diagnosis,
Treatment.
b . INJURIES AND DISEASES OF THE SPINAL MARROW,
ITS MEMBRANES AND NERVES*
I. CONCENTRIC DISEASES,
I* WOUNDS,
Varieties.
Causes.
Symptoms.
Prognosis,
Diagnosis.
Treatment.
C 110 )
Causes,
Symptoms.
Prognosis *
Diagnosis.
Treatment.
Causes *
Symptoms.
Prognosis*
Diagnosis.
Treatment.
Causes.
Symptoms*
Prognosis,
Diagnosis.
Treatment.
II. CONCUSSION.
III. COMPRESSION.
IV. CONGESTION.
V. INFLAMMATION, OR MYELITIS.
Causes,
Symptoms ,
Prognosis,
Diagnosis,
P is section.
Results, or products .—Convulsions, epilepsy, paralysis agitans, either gene¬
ral or partial, tremor mercurialis.
Treatment.
VI. INFLAMMATION of the MEMBRANES, OR SPINAL MENINGITIS.
Causes.
Symptoms.
Prognosis .
Diagnosis.
Dissection.
Treatment .
II, ECCENTRIC DISEASES, OR THOSE OF THE EXCITOR NERVES.
These are certain forms of epilepsy, puerperal convulsions, tetanus, hydro-
pnobta, hysteria, chorea, stammering, asthma, vomiting, tenesmus, strangury,
and abortion, Most of these affections are treated of under other heads,
III. DISEASES OF THE REFLEX OR MOTOR NERVES,
Spasmodic strabismus, spasmodic tic, spasmodic torticollis, spasm of :he
respiratory nerves—already referred to.
( 112 )
Definition.
Causes.
Symptoms ,
Diagnosis.
Prognosis.
Treatment*
HORDEOLUM-
Definition.
Causes.
Symptoms*
Diagnosis t
Prognosis ,
Treatment.
TYLOSIS.
Definition.
Causes.
Symptoms.
Diagnosis.
Treatment.
mADAROSlS*
Definition.
Causes.
Symptoms,
Prognosis.
Treatment.
TRICHIASIS,
Definition .
Causes.
Symptoms.
Prognosis.
Treatment.
distich iasis*
Definition.
Causes.
Varieties .
Symptoms.
Diagnosis. ■
Prognosis ,
Treatme?it.
PTOSIS.
/
ECTROPIUM,
Definition .
Causes.
Symptoms .
Prognosis.
Treatment.
i
( 113 )
ENTROPIUM. *
Definition.
Cause *
Symptoms.
Prognosis.
Treatment.
ANCYLOBLEPHARON AND SYMBLEPHARON.
Definition.
Causes.
Symptoms.
Prognosis.
Treat merit.
i
EPICANTHUS.
Definition.
Causes.
Symptoms.
Prognosis.
Treatment.
TUMOURS.
Varieties —Naevi materni, encysted, half-encysted, tarsal tumours, chalazion,
or grando, milium, and verucae.
Causes of each.
Symptoms of each. [y\ ik
Diagnosis .
Prognosis.
Treatment.
MALIGNANT DISEASES.
The lids, like all other portions of the body, are sometimes involved in ma¬
lignant diseases, by which they are partially or entirely destroyed. These
cases are generally troublesome, and often require an extensive operation for
their relief. (See Blepharoplastic operations.)
II. INJURIES AND DISEASES OF THE CONJUNCTIVA.
FOREIGN BODIES LODGED IN THE EYE.
Various kinds.
Symptoms.
Mode of examining the lids.
Diagnosis.
Prognosis.
Treatment.
WOUNDS OF THE CONJUNCTIVA.
Varieties.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
8
C 114 )
SIMPLE INFLAMMATION OF CONJUNCTIVA*
Causes —1, Constitutional* 2. Local.
Symptoms.
Prognosis,
Diagnosis,
Effects of products.
Treatments—l, QeneraL 2. Local
CATARRHAL OPHTHALMIA.
Definition,
Synonymes , — Conjunctivitis catarrhalis, conjunctivitis puromucosa catarrh-
aiis, ophthalmia purulenta metior, cold blight, &c.
Causes *—Cold in some shape, often accompanying influenza, and is occa¬
sionally epidemic.
Symptoms.
Diagnosis,
Prognosis*
Seat of the affection —Seldom involves any other tissue than the conjunctiva.
Terminations r.
Treatment *
PURULENT OPHTHALMIA.
Definition,
Varieties —That of newly-born children, and that attacking adults. Acute
and chronic*
Symptoms,
Diagnosis,
Prognosis,
Terminations or products _ 1, Sloughing of cornea, 2, Ulceration. 3.
Opacity of cornea. 4. Bursting of cornea. 5, Adhesion of iris. 6, Detach¬
ment of conjunctiva* 7. Staphyloma. 8. Ectropium, or Entropium*
Treatment*
UONORRHffiAL OPHTHALMIA.
Definition,
Varieties*— Acute, chronic, and that involving both the conjunctiva and
sclerotic coat.
Causes —Is it contagious?
Symptp7ns.— lti each variety.
Diagnosis.
Prognosis,
Effects.
Treatment,
ERYSIPELATOUS OPHTHALMIA,
Definition.
Causes *
Symptoms.
Diagnosis *
Prognosis.
Treatment *
( 116 )
Causes,
Symptoms.
Diagnosis,
Prognosis,
Effect on lids.
Treatment,
hypertrophy of conjunctiva*
Definition .
pterygium*
Varieties —i. Tenue. 2. Crassnm. 3. Malignant. 4. Single. 5 Pannus.
Location .—Usually the inner cant bus*
Age most Haifa. —Adult,
Causes .—Often obscure.
Symptoms and growth.
Diagnosis ,
Prognosis *
Pathology,
Treatment.
Causes ,
Symptoms,
Diagnosis.
Prognosis.
Treatment.
XERGMA, OR DRY CONJUNCTIVA*
POLYPI, WARTS, AND OTHER EXCRESCENCES OF THE CONJUNCTIVA.
Characteristics of these tumours.
Causes.
Diagnosis.
Prognosis.
Treatment,
III, INJURIES AND DISEASES OF THE CORNEA.
Varieties,
Symptoms.
Diagnosis .
Prognosis,
Effects.
Treatment,
WOUNDS*
Varieties,
Symptoms,
Diagnosis,
Prognosis.
Effects.
Treatment,
FOREIGN BODIES IN THE CORNEA,
I B P.liJ i mML U l
( 117 )
INFLAMMATION OF THE CORNEA.
—l. Acute. 2. Chronic. 3. Partial. 4. Complete. 5. Scro-
Causes -1. Constitutional. 2. Local.
Symptoms,
Diagnosis.
Prog7iosis.
Effects.
Treatment.
SUPPURATION OF THE CORNEA.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Effects.
Treatment.
ULCERS OF THE CORNEA.
Causes .
Symptoms.
Diagnosis.
Prognosis.
Effects.
Complications. —Hernia corneae, fistula cornea;, &c.
Treatment.
OPACITY OF THE CORNEA.
Varieties.—1. Arcus senilis. 2. Nebula. 3. Albugo, or leucoma. 4.
Macula. 5. Congenital.
Causes.
Symptoms -In each variety.
Diagnosis,
Prognosis,
Effect on vision.
Treatment — 1 . General remedies. 2. Local remedies 3. Cunier’s opera¬
tion. 4, Bigger’s operations.
STAPHYLOMA.
Definition.
Extent. — 1 . Partial. 2. Complete.
Shape -Varies. Hence we have the staphyloma hemisphericum, globosum,
conicum, rac^mosum, &c.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Structure.
Tnatme7it.
( H9 )
H^EMOPHTHALMUS.
Definition.
Causes.
Symptoms.
Diagnosis.
Progfiosis. •
Effect.
Treatment.
Definition.
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Results.
Treatment.
#
Definition.
Causes.
Symptoms.
Diagnosis .
Prognosis.
Results.
Treatment.
AQUO-CAPSULITIS.
HYPOPYON.
DROPSY OF THE ANTERIOR CHAMBER.
Definition.
Causes.
Symptoms.
Diagnosis.
Prog?iosis.
Results.
Treatment.
VI. INJURIES AND DISEASES OF THE IRIS.
IRIDEREMIA.
Definition.
Causes.
Appearance of the eye.
Effect 071 visio 7 i.
Prognosis.
Treatme7it.
COLOBOMA IRIDIS.
Defi7iition.
Caxises.
Appeara7ice of the eye.
Effect on vision.
Prog7iosis.
Treatme7it.
( 120 )
CHANGE OE COLOR IN THE IRIS*
Causes.
Appearance of the eye.
Effect on vision.
Prognosis,
Treatment.
PROCIDENTIA, OR STAPHYLOMA IRIDIS*
Definition.
Causes,
Symptoms.
Effect on vision.
Prognosis.
Treatment ,
SYNECHIA.
Anterior and posterior.
FUNGOUS EXCRESCENCES AND TUMOURS OF THE IRIS
Varieties.
Causes.
Symptoms.
Prognosis.
Treatment ♦
MYQSIS*
Definition.
Causes.
Symptoms.
Effect o?i vision.
Prognosis,
Treatment,
MYDRIASIS.
Definition,
Causes.
Symptoms.
Effect on vision.
Prognosis.
Treatment ,
Defimtio n.
Varieties.- —
Causes.
Symptoms,
Prognosis.
! Treatment.
( 121 )
TREMULOUS IRIS.
Definition.
Causes.
Symptoms.
Effect on vision.
Prognosis.
Treatment.
IRITIS.
Definition.
Varieties. — 1 . Acute. 2. Chronic. 3. Idiopathic. 4. Sympathetic, which
includes the syphilitic, arthritic, &c.
Causes. —1st, or constitutional, as syphilis, gout, rheumatism, scrofula,
cold, wet, &c.
2d, or local.—Direct injuries, over exertion of the eye, &c.
Age most liable.— Adult and old age. Rarely occurs before puberty.
Symptoms.—- 1 . Constitutional. 2. Local. These are of course modified
by the extent, duration, and intensity of the inflammation.
Effects of this inflammation .—1 Effusion of coagulable lymph. 2. Change
in the color of the iris. 3. Displacement of the iris. 4. Hypopion. 5. Effusion
of blood in the chambers. 6. Adhesions between the iris and cornea, or capsule
of the lens. 7. Loss of motion in the iris. 8. Closure of the pupil. 9. Atrophy
of the globe. 10. Opacity and thinning of the cornea. 11. Partial or entire
loss of vision.
Diagnosis.
Prognosis .—Depends on circumstances ; for the most part it is unfavorable.
Treatment. —Three indications—1. Arrest the inflammation. 2. Prevent
the further effusion of lymph, and promote the absorption of that already
secreted. 3. Prevent the contraction and obliteration of the pupil. Remedies
to be employed for the accomplishment of these indications.
OPERATIONS FOR ARTIFICIAL PUPIL.
Object of these operations.
States of the eye requiring the operation.
Proper condition of the eye for an operation.
Prognosis.
Position of the artificial pupil.
Should we operate when one eye is sound!
Should we operate on both when both eyes are diseased.
Preparation of the patient for an operation.
Various operations described —Three principal methods at present in vogue.
1. Incision. 2. Excision. 3. Separation.
Relative merits of each.
Formation of an artificial pupil in the sclerotica.
( 122 )
VII. DISEASES OF THE CHOROID COAT.
CHOROIDITIS.
Definition,
Varieties —Acute and chronic.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
DEFICIENCY OF PIGMENT.
VIII. DISEASES OF THE RETINA.
RETINITIS.
Definition.
Varieties — Acute and chronic.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment ,
AMAUROSIS.
Definition*
Synonymes.— Gutta serena > suffusion.
Varieties _1. Idiopathic, 2. Sympathetic. 3, Symptomatic. 4. Incipient,
or recent. 5. Inveterate* or con Armed. 6. Partial. 7. Complete. 8. Organic.
9. Functional. 19. Continued. 11. Intermittent. 12. Periodical. 13. Local,
or nervous, 14. Complicated.
Causes. ^Several classes*—
1. Those operating immediately on the nervous apparatus of the eye.
2. Those operating indirectly through the medium of some other organ, or
by sympathy.
3. Those operating through the medium of the sense rium,
4. Congenital causes.
Symptoms —Depend on the stage at which we examine the case.
Diagnosis —-May be confounded with cataract, glaucoma, mu sea?,
Refer to the catoptric examination.
Prognosis .—Depends on the cause , duration , and degree of the attack.
Influence on the sound eye when but one is affected.
Pathology. „
Treatment. ~ Modified to suit the peculiarities of the case.
( 123 )
Definition,
Causes.
Symptoms*
Diagnosis.
Prognosis*
Pathology f
Treatment*
WEAKNESS OF SIGHT.
Definition*
Causes*
Symptoms.
Diagnosis,
Prognosis*
Pathology ,
Treatment.
AIUSC^ YOLITAHTES*
Definition*
Causes.
Symptoms*
Diagnosis.
Prognosis*
Pathology *
Treatment.
HEMERALOPIA
Definition*
Causes.
Symptoms.
Diagnosis*
Prognosis*
Pathology *
Treatment*
NYCTALOPIA*
Definition*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Pathology*
Treatment.
HE MIOPIA.
Definition*.
Causes*
Symptoms *
Diagnosis.
Prognosis.
Pathology *,
Treatment*
NEAR-SIGHT
( 124 )
FAR-8IGHT.
Definition..
Causes*
Symptoms.
Diagnosis*
Prognosis,
Pathology *
Treatment.
PHOTOPSIAr
Definition.
Causes*
Symptoms*
Diagnosis*
Prognosis*
Pathology*
Treatment*
CHRITPSIA, OR COLORED VISION*
Definition*
Causes*
Symptoms*
Diagnosis*
Prognosis*
Pathology *
Treatment*
IX, DISEASES OF THE LENS AND CAPSULE.
CATARACT*
Definition --Partial or complete opacity of the crystalline lens, of its cap-
sole, of both conjointly, or of the liquor Morgagni,
Varieties* -Lenticular, capsular, capsulo4entieuIar, and Morgagnian; true
and false; radiated and aborescent; hard, soft, and fluid, and cataracts of
various colours; congenital and acquired.
Age most liable*
Causes,
Symptoms .,—Impaired vision, opacity in or behind the pupil, &c* kc.
i Diagnosis.—May be confounded with amaurosis, glaucoma, weakened sight,
deposites of lymph, &e. Use the catoptric test to ascertain the true character
of the case.
Prognosis *—Depends on the complication of the case, its duration, &c.
Progress of the defect,
Question of operating when but one eye is effected.
Treatment .—Nothing short of an operation will cure the complaint. Several
operations have been devised, viz : 1* Extraction. 2. Depression, or couching.
,J ' Keelination, * 4. Solution or absorption. (Anterior and posterior operation.)
Appreciation of these different operations*
Description of each , and the instruments required for its performance.
Preparation of the patient*
Season most favorablefor oper&H?ig*
After treatment*
Condition of the eye when the operation succeeds*
Cataract glasses.
( 125 )
GLAUCOMA*
Although this affection, strictly speaking, cannot be considered an affection
of the Jens in every case, yet as glaucoma is often confounded with cataract, and
the lens is often involved, it may be as well to speak of it under this head.
Definition.
Causes,
Symptom#.
Dtagno sis >
Prognosis.
Pathology.
Treatment*
X* DISEASES OF THE GLOBE OF THE EYE*
INFLAMMATION.
Causes >
Symptoms.
Diagnosis, \
Prognosis.
Treatment.
HVDROPHTHALMIA*
Definition,
Varieties — L Dropsy of the anterior and posterior chambers, 2. Dropsy
of the vitreous humour. 3, General dropsy of the eye-ball*
Causes,
Symptoms in each form.
Diagnosis*
Prognosis,
Treatment ,
ATROPHY oE THE RaLL.
Causes*
Symptoms*
Diagnosis.
Prognosis.
Treatment*
collapse Prom suppuration*
Character of the defect.
Mode of relieving the deformity.
EXOPHTHALMIC
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
( 126 )
XI. AFFECTIONS OF THE LACHRYMAL ORGANS.
INFLAMMATION OF THE LACHRYMAL GLANDS.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ENLARGEMENT AND INDURATION OF THE LACHRYMAL GLAND.
Causes.
Symjjtoms.
Prognosis.
Diagnosis.
Treatment. ,
EPIPHORA, OR EXCESSIVE SECRETION OF THE TEARS.
Causes.
Symptoms.
Diagnosis.
Progtiosis.
Treatment.
STILLICIDIUM LACHRYMARUM.
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
%
XII. DISEASES OF THE CARUNCULA LACHRYMALIS.
ECANTHIS.
Definition.
Varieties. — Innocent and malignant.
Symptoms.
Diagnosis.
Prognosis.
Treatment. \
TUMOURS OF VARIOUS KINDS.
XIII. DISEASES OF THE LACHRYMAL SAC AND DUCT.
INFLAMMATION.
Causes.
Varieties .— Acute and chronic.
Symptoms .
Diagnosis.
Prognosis.
Treatment.
( 127 )
ABSCESS-
Causes.
Symptoms*
Diagnosis*
Prognosis.
Treatment.
FISTULA LACHRY31ALIS.
Definition.
Causes.
Symptoms*
Diagnosis*
Prognosis*
Treatment*
PERMANENT OBSTRUCTION OF THE NASAL DUCT.
Causes*
j Symptoms.
Diagnosis*
Prognosis.
Treatment.
CONGENITAL DEFICIENCY OF THE NASAL DUCT,
Operation for its relief—(see Derard.)
XIV. MALIGNANT DISEASES OF THE EYE,
Causes*
Symptoms.
Diagnosis*
Prognosis *
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis*
Treatment.
Causes.
Symptoms*
Diagnosis.
Prognosis,
Treatment*
Causes*
Symptoms *
Diagnosis*
Prognosis *
Treatment.
FUNGOUS EXCRESCENCES*
CARCINOMA OF THE EYE,
FUNGOUS HEMATODES OF THE EYE.
MELANOSIS OF THE EYE*
XV, EXTIRPATION OF THE EYE,
Mode of performing the operation.
IV. DISEASES OF THE EAR.
Anatomy of the Ear — Divided into external, middle, and internal
external ear consists of the auricle, and the meatus auditorius extern
MALFORMATIONS OF THE EAR.
MALFORMATIONS OF THE AURICLE*
Cases most frequently met with -1. Deficiency of helix, and sometimes its
division from the lobus, 2, An entire absence of the lobus—its division by a
slit into an anterior and posterior portion—or its attachment wholly or partially
to the integuments of the side of the head. 3 The tragus and anti-tragus are
sometimes united, or inverted so as to partially close the opening of the meatus
4. The total absence of the auricle. 5. An enormous enlargement of the
Causes.— 1. Congenital. 2. Acquired, from wounds, bites, ulceration
sloughing—an increase in size is often the result of manipulation, or of the
jTI V - ira c: £■« l-L - -A * ? *
dress stretching the part.
Effect upon -sense of hearing.
Treatment.. By artificial ear, by removal of overlapping portion, by dila-
tahrth , J
MALFORMATIONS OF MEATUS AUDITORIUS EXTERNUS*
Most frequent varieties — 1 . A very narrow canal. 2* An unusual short¬
ness of canal* 3 A total absence of canal. 4. A closure of the canal at
birth by a slimy caseous matter. 5. A closure of the orifice by the integument
stretching across it and being attached to its margin ; or by a membrane in any
part of the canal; by a Contraction in the cartilage, or by undue ossification oV
the bony part of the tube.
Causes. —MostIy congenital—sometimes acquired.
Effect upon hearing,
Examinati on of meatus e%termts+
Prognosis -Modified by cause.
Treatment* —Varies with the case*
9
( 130 )
MALFORMATIONS OF THE MIDDLE EAR.
Importance .—Most of them are attended with deafness, and the cause is gene*
rally not to be removed.
Most frequent variations .—1, The cavity has been found much smaller
than usual, 2, The cavity has been inordinately large, 3. The outer wall
has been ossified — in fact a bony plate has occupied the place of the membrana
tympani. 4, The ossicula? auditus are often varied in their conformation, thus
one or more of them may he too small or too large or deficient in ossification,
or ossified together, or altogether wanting. Supernumerary bones have also
been found. 5. The tympanum has been found filled with a soft white matter
resembling inspissated albumen ; also with a scrofulous deposits* 6. The
eustachian tube may he wholly or partially obliterated.
Games .* —, 1. Constitutional. 2. Acquired,
Diagnosis > — An examination will teach the condition of the membrana
tympani, Catheterizing and injection of air will teach the condition of the
eustachian tube.
Prognosis -Only favorable in partial obliteration of the eustachian tube.
Treatment. — Varies with the kind and cause.
MALFORMATIONS OF THE INTERNAL EAR.
Various malformations of the labyrinth have been noticed—it has been
entirely wanting—it has been deficient in ossification—change in quantity and
consistence of the liquor cotunnii has also been observed.
Such deficiencies are of course beyond the reach of art.
WOUNDS OF AURICLE.
Usual varieties „—-Incised, lacerated, contused.
Treatment . — Differs in no respect from that for similar injuries in other parts ;
bearing in mind the deformity resulting from the loss of even a small portion,
union is always to be attempted*
PARTICULAR DISEASES.
OTITIS,
Definition .—Generic term, implying general disease of the w hole organ.
Division of —Acute, chronic, external, internal.
External includes inflammation of the auricle, and of the meatus auditor!us
extern us.
Internal include^inflammation of the tympanum and labyrinth.
Causes —1. Exciting, 2. Predisposing.
Symptoms and consequences ,-—As acute inflammation seldom attacks the
entire organ at the same time, or from the same cause, these vary according to
the structure of the part inflamed, and will he described under the heads of
diseases of particular parts.
• *
m
,
■s.
)
( 131 )
I
ACUTE EXTERNAL 0T1T|S,
Seat— Sometimes commences simultaneously in the auricle and meatus_
more frequently it extends from the auricle to the canal—it however is some-
times limited to the meatus,
Mon frequent forme - Erysipelas, erythema, in short, all the inflammatory
actions, either common or peculiar, which affect the cutaneous system.
Causes ,
Symptoms . with the form.
Consequences,
Diagnosis,
Prog no sis , — Fa vorab 1 e,
Treatment — 1. Local. 3. General.
ACUTE INTERNAL OTITIS.
INFLAMMATION OF TYMPANUM AND LABYRINTH.
Forms -Primary. Consecutive,
Seat —Mucous lining membrane at first, then extending to cellular tissue, to
periosteum and to the bone itself.
Causes -Exciting. Predisposing.
Symptoms —Agree with those of external otitis, differing only iti conse¬
quence ot their much greater severity, and of the circumstances of the matter
formed not finding a ready outlet.
Consequences.
Diagnosis .—May be confounded with external otitis, with meningitis or
phrenitis,
Prognosis .— Grave*.—as troublesome otorrhea may result—the ossicula may
be lost—the membrana tympani or the mastoid cells may be perforated_.per~
manent closure of the eustachiau tube may result—or phremtis, meningitis,
and death may follow.
Treatment,
CHRONIC OTITIS.
DIVISION—INTO EXTERNAL AND INTERNAL*
External is divided into that of the auricle and that of the auditory meatus.
Chronic Inflammation of the auditory meatus includes —
1st. Erythema of meatus with diminished secretion,
2d. Inflammation ot dermal membrane with inordinate secretion.
3d. Polypus* fuugus, and vegetations of auditory canal -
4th. Sinus of meatus,
0th. Inordinate ceruminous secretion.
flth. Aphtha; or herpetic ulcerations of lining membrane of meatus.
C 132 )
CHROMIC INFLAMMATION OF THE AURICLE.
Definition, - /
Causes,
Symptoms,
Diagnosis.
Prognosis
Treatment —Local and constitutional, as the local affection is often main-
tained by general derangement of the health*
CHRONIC INFLAMMATION OF MEATUS AUDITOEIUS
EXTERNUS*
ERYTHESTATIC CHRONIC DISEASES OF THE MEATUS*
Synonyme —VOtite chronique seche* (Roche.)
Can ses .— General de ra n gem e nt s of health*
Symptoms ,— Uneasiness, slight pain, itching, dry sensation, difficulty of
hearing, tinnitus aurinm.
Diagnosis .—^Tube unusually dry—wax in small quantity—most frequently
a vitiated secretiop of a white or yellowish scaly matter*
Prog no si s * —F a vorah 1 e.
Treatment .—Attention to general health—tonics—counter irritants—
ast rin gents,
- v -■ s, / ' ... ■ V'; ; ' -, , v $
II* CHRONIC INFLAMMATION OF DERMAL MEMBRANE WITH INORDINATE
SECRETION* •
Synonymes; —Humid chronic external otitis, (Roche,) mucous or catarrhal
otorrhoea. (Itard and Andrah)
Frequency of occurrence .— Yery frequent.
Age most liable _ Childhood—sometimes occurs in old age*
Ca?£ses ;—Acute inflammation—irritation of dentition—metastasis of gout,
gonorrhoea, and mucous ophthalmia — presence of a foreign body.
Symptoms ,-—Usually mild—uneasiness—audition slightly diminished—.
fuse discharge either serous, mucous, or puriform, or mixed.
Diagnosis.
Prognos is *
Treatment ,— Removal of tb<* cause—Improvement of general health—ciuh
tious use of astringents*
III* POLYPUS, FUNGUS, AND VEGETATIONS OF AUDITORY CANAL*
Difference between jf/iem,*-^Polypus is oval or round, attached by a single
root, usually regular in its shape and firm in consistence. Fungus is a mass of
exuberant granulations, soft and vascular, irregular in its shape and attach'
ments, and always attended with free discharge. Vegetations consist of numC'
reus small diseased growths, sometimes soft and fungoid, at others, firm and
conical, and attended with slight discharge*
f
-J-
1/
fz ^ £& ~ *c f€Xr^{f ^'iep: f« &* i *p
/- ^ 2 **j f , ~ A* - ^h&^4+mp?£ *A— riogfs/—
vfjf <&}&*<*£ £ j&r^ ^ ***&(l*4~P^ &/ ^ rr *Z^
*&/&?/} ty* ^6^
$&"A-cd- */£ 1^*** *- ' f /£&& &*^C
£u*^ &y& CZ+C&) Wi l t & t £y ^<0sC^
A. , £*£ * # ^;/^7-? <L^
9^ #^<J .rv
> * £: * J \
fa-zstsi rt^t-1^. <\, 14-tm,-''' pa €t t • C^ ^
(?%t— ^ fe-%~? fit* * -.,^ v p*' ''V’^HP^r', ■
i^Ci) p> fi^.7o 1/t t 6^4 **■ ,*' C j
^tyr^«C-w-V* ^Aj-f.-^ £**-p' /<4,4'\> ,J <£*“ . i > ~
/ rf/tdU^ . A+«*-C- i/b t/€*ei 4 < ? * *,
/ /' jfrisrtZvvi* 9 <x/t<\ r < t.j^i /$£* * jtj ^L> c4f
*" i j^~c — , ^ ^ *- *$*■% ■*
0h*A s7' '•% /#.'<:' .'" ?/■ fc^l— -'
^ 7 ^£4zz>^ t/7 /'»'. &> /&H,
£st*tS ii*s - m ^
hnr~t^C^<^<» £4 'f>Y^te-s *r _ iQ*£sJ- L4 Z*6*-& **
A^7 < , _
^' CZU ^ a >^ w ^ ■ ts ~fc7T/U **** £~
—>^ -> '1 ^ ' j^ *.
^J_. fM-*p 0 t-
(HZfiv fr'\sZ*Iy c
H^tv>^6| ^ inr* L®\/d
& * ^*1
I
<W& / tcJ ^. i -v-u |
v 1
¥ *
Cts. — 6-t^f
C*6kM
-rW I # 1^.
Wv'fc Gi
C<_r< : -
(YtrV'f'3 iQ'tCt)
yzju j 4 hi*v6-A-tvt? «
v — ^L^i"
to' ^ p&-op ,fnw c/R-.
^ ^ <UiW fa'U^ JXi*
■N-V* - tvw- f* f /' /viA-V C‘/'U.. [/*0v
i h’ k |yC^v\ji ^ fi/iuc-v
w
V
ify £>^~
(y%4 u tfd-t a*- **& *-
hat^v-^ &f^4' £<r*~<s Q^~cS/o^Ci^d —~ d>u~
^‘Xi^cu —■. - v j&*Jo fKc.
iCXw'f* d£^V JhiAd&4* Ad C*t***d
fh^-z3S$g, Av/ ,
(Pu- 4-4& jlv*. ad Gl*4 * ^|
($£- &f ■ £%*- f'V dlta-i ^1
/mt 5 c<W^, ct-*^-^ >tr-tJv^££_, i> * -
<J^£-*.- \,.jsg0 ~C‘*iX•&*—
Cwdfa ^ <^'-*7 f** u- ^*f w /^W &fayh «» t-wl
<m^i#4£ * <£*-Cb jfoAL*..
fi 6 *~C*-~* tn W tf / *e? i*. f n .
$**1* {/ s /+~£tc CAo-hJq ' £-3
i?6‘"p ■( -t <Y jC __ <3£**Hgf i t./*-i^
A^^Oy 'cLt*^ /&*-**,, mj/1-
old) ♦/v' i/1-% Zt t*J f- /&*
1 &1> _> (/ £*<2 frXt'X't-ur- d^J&Ac r - ■
yflAt-#£***# fo&i, &c*fi**r£* *~ t
/l/7u-'r «- y*-~-'’J‘ /£t < ct' £
fc»- ', £ *- ^ ' £fcV 4^"^“’ *~
/- s% e^J4 & dl &
D — ^^**d
v=^ ^ C* ^ ** * '^3^
t"V pv ^ ht'irv^ ad/^ ’ J tv‘ <***77
ft^yy C f '<?/ *?, Str ^ /Qd
Mud <&rt$ l?Ud b&jiko
l/PUi^'i (jUrw*^ &c
f‘<
t/fcUlfr'i (jtA W^ &sd & J hist
fault l4x u t-Udfo &* d &*. dtc^ n '
/r
I ^w|" f wC ■ iMA^d
I
csf *
'S&L&/L /
1?f, 4 K ^ cu^P L.fh_^ t
vJ/i /®L. (J&H-vf; jf'fa lM ff pl^./\
tA r £/yv & y* t/Krp. U . y j A JL -. jn'l
(y^ ^AAryiy^ 1/vJsC-^/ ^i,'VofyL
|«4^| ^ M v{] \Am^—^
PrrfU^ tr £ 4 , dk&tH*** *%,6
^PVkr $wnsL$ <s%-0 &**%>*,&£&
jf£tfxsp^ d'ttsjb*
k/t /v^^vv
xyo
<st*
/*-
** -*v M^C*v
ytu ^
/V^VM^ ?l\r'^> /j/ ^ 4 /---f^C **& if
J^pj flCaA^ be* ~ A^l^w e ^u^i-
g&S&k** *$?
HA* 6&0~*£J
o***. t -4 Gt'Ktjfcj
$/ fast.jf ’H/ A f'n wCJ^ fehrYHftomr /*?.
■***£ Wt' ^?'Mi \.?{*<s+-C^
'A-'4 c L ~tt^A- r a4(j $£****£ /^* *v 'S't^f^
yi
(ZZl'/ rtt Ay /-
(h~^ jy^t >
Ia- 4~ ^vt / i^p-HZ $*frC4b’i m0l + ^__
Qj/^sj&tu t.-cLy&Xf^ L^y^0as^^‘t</- — {A*J*+*>'
fy^i'iv b-C^Q-et, Cyd i'j &t>^^rCrt-J M^*p--'
Ay- - j^l it K ^ j*W.ft "/ •; 'H? ^
' [t^Ww 0 if\*--i\s ^ ; v<3 —^ /
tw f^xt^ (*jfc%»,J&*~£ffir£f\*a
.!• t -ij/a ^1 te t^^Li <j ww &is^.U L
I $X7 bWV frfLpv4t+4~ „ 9 fcgr Qtwf- Cj hi
(^\sjJits4 fl/W t (a^w^O~ £&^ fcsW\}\
- U''* ^ %£<io __
/yt> — fcv C&XtZ} C^~P~Ct,w~£ (<
£i i /t) (Ar\. t <&-^ ITikZ-s by\~C-QJr £ &,<*- y H/h
l Y'"'' )ji Cu U'\ cl/A fa^
okl^i" CK^Si) fj-^14 0 ?\>~^/L*caM Jo c^Jjp
J ^'t^y/' *** ck<i to &c/b 6 *aA (^t' r\ c ^7 i^
4r-^' w ~£- t-VuMri t ^~/. ^ k frti C 4~* —’
wW-{r(MM a**/' TiniffT^ m*.
t jirta4r4KL'\i& —. Av) *3 —' J&itiUw
^ ’ ( t 0 lT p h^ cJ^ty Lj^
p J-wW ^ /-?^o (K^Heo
h-fr^O CUA^Vt^S " ^a-w^
#,<c- p cw - ' kuk^ /h/AI^a
u-r.—y iLc fcU Jo^d /u (U^uJ/s^
i$/py <&^/^v-Q ^ i ]/
v ^t? ^ a f L ^Aj. jTctLr r ,^4 ^u4a^C^ } (AsTr^
d^if^f^ P^JF- f/t-p ^
,fet^ City, Ci^-j Q^ts&O
h&faL. a / 'c^y- th ^ fj
- C-^v^y^ :Ot(^J^
Kt^>>^ 0-^~v- * *5 i^-({>wx ^ 'pd/tu
.. . ( 133 ) v •
. Causes.. —Chronic inflammation—local irritation from foreign bodies_in-
jury to lining membrane by the ear-picker.
Symptoms.
Diagnosis.
Prognosis —Favorable in polypus—not so favorable in fungus and vegeta-
tions.
Treatment.— By excision and caustics—by ligature—by extraction with
forceps—by caustics alone.
IV. SINUS OF MEATUS.
Definition.
Causes —An abscess external to the meatus—a diseased mastoid bone.
Syrnptoms.
Diagnosis.
Prognosis -Unfavorable.
Treatment -Modified by cause—palliative chiefly.
V. INORDINATE CERUMINOUS SECRETION.
Causes. Acute or chronic inflammation of the meatus.
Symptoihs:
Diagnosis —May be confounded with almost any of the other diseases of
the ear ; a careful examination must decide.
Prognosis —Favorable.
Treatment —Allay any existing inflammation; remove any inspissated
cerumen ; apply some gentle stimulant. Dangers arising from incautious
syringing.
VI. APTH JE OR HERPETIC ULCERATIONS OF LINING MEMBRANE OF
MEATUS.
Causes. —Chiefly constitutional.
Symptoms.
Diagnosis.
Prognosis.
Treatment. —Tonics, and alteratives for the general health ; local alterative
astringent' injections.
FOREIGN BODIES IN THE MEATUS AUDITORIUS EXTERNUS.
Nature of these.— Round and smooth substances, as beans, peas, glass beads;
sometimes, insects of various kinds.
Origin of Insects . «•
Symptoms -Those of chronic inflammation, occasioning an otorrhcea, where
the cause continues to operate for any length of time.
Treatment. —Removal of the cause will sometimes alone be sufficient; solid
substances may be removed by the forceps or by forcible syringing with warm
water; insects may be removed by a few drops ofuil, or of infusion of tobacco.
he. he.
Dangers arising from force applied for the extractio7i of foreign bodies.
( 134 )
INTERNAL CHRONIC OTITIS*
CHRONIC INFLAMMATION OF MEMBRANA TYMPANI*
Causes.
Effects ,—U lc eration ; pe rforation; com plete d es t ru ct ion I
Mode of inspection mid exasniuatio u *By speculum ; by forcible expira¬
tion ; by sounding and by tbe otoscope*
Symptoms.
Diagnosis. be confounded with disease of meatus, or of tympanic
cavity.
Prognosis.- —Unfavorable to audition*
Treatment*
CHRONIC INFLAMMATION OF TYMPANUM*
Forms ,— Primary. Consecutive,
Seat of disease, —Mucous membrane ; frequently extending to the cellular
tissue, and onwards to periosteum and bone.
Causes.
Effects ,—Perforation of membrana tympani; loss of ossicula ; abscess of
mastoid cells ; caries of petrous bone; effusion of pus under dura mater or
between tbe cerebral membranes*
Symptoms,
Diagnosis .— May be confounded with other inflammatory diseases of internal
ear, with meningitis or phrenitis.
Prognosis .— Unfavorable,
Treatment .— Modified antiphlogistic ; injections of mild fluids through tbe
eustachian tube*
RELAXATION OF MEMBRANA TYMPANI,
Definition.
Varieties.—1. From want of tone in the membrane* 2. Paralysis of the
internal muscles of the malleus, 3, Rupturoof the same muscle
Causes of each.
Symptoms. *.
Diagnosis * *
Prognosis .— Of first two, favorable ; of the last, unfavorable*
Treatment* —-Dry warm tonic applications ; tonic and astringent injections
CARTILAGINOUS ANB OSSEOUS CONDITION OF MEMBRANA TYMPANI*
> Causes *
Sympitonls.
Diagnosis.
Prognosis*
Treat ment ,—By pe rfo rati on,
History of operation -First proposed by Cheselden ; proposed and per¬
formed by Sir Astley Cooper in cases of obliteration of eustachian tube*
i
\/€^ da CL '&£*' h ~-r,
yfa^Md . k)w f' ,‘ dA.« L, ^P
fi {h\Af*-§' Ot^h- ^Vu-wjd^-T' **" d*&JAC* r dt/€^
IpTHsMlt' 4jfrr\ts SKif~ '£ ASfeih k tc& hh^c,-.
Ct/TA-Cs — H - n^ jjts&st *w j
*- ^vv ( ~'tjjrk' wfaye** x
Lj6i(U2) - {£/■'* £ J
V ffi/h—fr' ~£%%S ^ ^t. yL __ 3 &■
A A> ‘» (-•'**■ £/. / ’ v
- J4^ * --- &iec*A<^
^jsu*^£ c^ Jl— ££t£
/hW" Lo-ifo? ^H-rfeX-'J f'fi’hti-t) $-&&& V-\fihfy
i^'W-v^? ^ Jcnrt/y^T- C+'C ^Jvw ^ -gj
^t^fhUCc^ tf Au-A^t $^/uHl t{) <C*~ r 0U£
1^} fi-i&y'-C., dc‘ C&n-d <”/ Z A' -
rr. _
//
/* *
U-'t'-
Ct, l "
fyrJZ&J
1
'W £*A: Joxa^C^^Cu^ crCiSti* Ij ■& hdzjl
ft * $*rt*y*- -~&i~ r t//<~ ^v/ l/ , 4 't' •''-' JPirZy,
v (&) ^|U.<W< ■'V
^Ag^J> C'jSAfi vS t^ Urtstt, .£-&-
(phCcls t ‘“tti C J * ■ f••'
Cft^vkcU, i<> / ^p l '( ^-
t/J^ ~ dUfoJr h-iv t (X._J^ <*-2 {/*''-' '-i
, Oi^p^h. CiC I cf) (X-w\iA jpj(sPJ$Pzzr Ct—i)
jy^JX' i>t f^w- ‘ , /uJ/rA^
tv r'tc Ct&dirkfr- ■
/ ' ' J .Ccdr. ' , U-a, t^V" C
j’j r \aaj &f'7yts C ', O'l^D ^..
yu 4 l l*vU& -dufj'mvf*~
G£b 4 AAiMt*)V kv&s P~&JL; fa
M Sm&hr*} (.Ir 4 '-$t 4
*&**'/■' • /£■(£ „
p) Cyi-ii /t *-*-' v ^ f , ; K? 4^
4 M*&\ Ptj k\ I
/f^ 1 - 5 ^ ■* ^f/ty / jfyi
^|vvA' J HtfW 7 '■'^'fcPijj ^
*’■ .PImWSi^c, £/] $ 1 H._ X jl -
A )3 " <hlA$JL }hC\*yb &$$$#&&} ^■ fi'f'tt--(^ mi _
pt 9 c * M'Wl M 4 ‘ti-v ht -H*
pplrt-~ - 7 if>i»- 6 iti& Lrev^/ £tg^r. A
j-^Uf *- :£i v ZUslLt Sh.# Atvji
-yM- (./.,■/ j u XW-- 'X
5 S^'i v 4 ^'))|, l^V ' >i) < -^t-*,'. 'I i J H/vV
^U*,-p fiA£, /td ^
UruS^Ucf^ ' :.<' ? w
XL fy&k&r- $*. M,4
& ' r ^^XJ)jU d>i^^ !/• &W b-C -* Av'l /-w
/ &hs.t4$k4j ’^*,/j j
“ <?» a 4 ^^>m /
ilLCtttCt It'tfrtS&f'.CL
EX' fc04t.1s £*V
A XUfto&fryJfcrkt*& n*> ftfwribui n 4 *iiZu>. ?*^ I
iMi^f'-'ir t’ fkCyX) A*¥$il>&64< i*$a. iM*& J ' !! H
■ cXjb-ts Cl! ■ ."w; ' IrVtS' I
ft "" ,
C^n^i r . Be^JJ ^vU/J —- V.4^/ ^ -X* UGL^jf .
1/^-f- ^LZt^- fc/4sjfO Xk*aw $ fl%%~£}y f/^l^Cy jL-&
1 Jl'ivp'jivis-iufcp >— Ko^C/ tf~'i&'» i- . /^./L^/jilif /.#• !<' |
AipOU' JloXL ~ Ji £X* lJt^Cs r <H i../-"/m >'- w /<<- /•***-''N
*‘ f 6M4""jfx.^ ./>*■* _, ^ £?(,-yti4 |
^ ktrvXw p 'O Xufrtoe&p^ a
/C^>;; ~fa&,XUpvJ /3 - Avtf ^UhL^ci^ ' ^p' 4 - J
/,( Hvn~frJ> jl fcyvv^i^-c c^j 'Ity-ring's) I
^Ot^LWVv' [H'-t'fe
/£< i d ^>nrVv-cxA^ C Gbfcxfi
\\\Ktl. &
9
CLJ
C#-*rbvt+*-f4j
— il/i--' Aav CLvvCv/^U @khv*~4- O^Crh>
fj /vtM> ^ tA'-'tMe**-^ . ^==3 P
j)C^>^ j^AlvCi 0)?tte J^A^l
" fe w 6 ft 16
■ ' v ’*•' -
i£&C
I vfitf* i&illvi* (ft l/^kfij - v^t^- — „
^iJifL^l - y/hich,. ft^AkU jf^el ft u t li
0&tl\vL(vflnv tj~T7t(Jdlhu^f tfllks, -
hif'Cy o) u ^U^rxyyt) Cb^ lltay _
S uJy/Kj^ J ftbfijj) fthMcla *) P^v-o <Qj , i ^ __
^5" ^ . L 0^5 j^iV-'C r -'UWY. d-v*-“t)
(LplVc*, iH €x 1 tJLscu~ 2 fcz,£ _A
^W<ru»w) l+tyfrc £im*A t-voj
U-lilv loVn^v 0?H*d (TjCa-j £UW /Z^Vt>- ol’-t')^ -_
S^cMCuJU^if^x^ J - ibrsiyik j^MJ[w|4
l '-l {^ 5 ^thrift' l 'AjlftUsi j CA vCt t/vvt
W CW, «■fc U«dt) iAnu*~ l&~urtA^
p-« - l(}Mr * fo<£) rUwO' (rbo
^ \A 0~ cXyLL |4i6y j
C> 4 { tv^WV^yv V 4 f vVv.'G,. v. X AdM fc;
&iAACt+*L\^ ' j fj&Jd tuS * £. y, (irv-id
O^Vlw| r>v d[ vVK /^ *-* '*-4 ^J-J) €^wwu«-i *
^nviv ftdu h.^y uU* iaAa4s>
(W ^ 4 ^ / 1 * tv *v L~ A^ &LUt^ J
K/ji |^».V ^-D Jo — t/tj . fo tt/)
^ v56w Q^ ^ j^fr vw A y *4 { AW
Llftt**#. /VKtN- Wt&vyU
vvt^V ’ tV. ^A-Ob . n^
^^2 /rnt fv> tw i-^,. a- ti | ju>* - ^tJ)
v;w ' 1 A/^-\o (jj\*
Ci.t O' >0
[M
>\/
^ — Ch {a $3
. *?%£ar
W-.
"tT (!U <Vw
J
IyK/u? (jJwvv/ tofPp fi^j eu&jw'*-' — 2 4m) LJnj'-i
>u Lx^jtf & "fe c hih t -' fi r t»'&h*/'9
$0U*' P '■ Jl ? f3* $&m r j
fafiJU** yn^c- ^ ** d*\£ utsu u*rr~C t
i/L*
t t ' f M
„ _ ^ , ibflh^ S /---1
/W- bsttsh, h A stMs'Jjei. .■ £"‘J : c
fir ev**jM&zau &A% *k **> t^n?
Ql6t44t**6- /ttodjfcm-i /{*<: ■£. ' ^
(jU^U'' Mtii t Iru-t &(A\i tj£s0 t/'t e* a ’
<j j4r /&4~yr.jj?r#ky
fa CtHjU- fuo^C- $.’Jt* cfol
\p7&^ / Y' fiLcJi^^r J/i“V-t / #) .fryer &-r*, gcc
JW fc/iU.* - &&oAaQ
fil $si/i-v>r' ? ; ti^ /{-tt U'd (r%Tt- 4 * A J t >.{{,■■*
A fty&AU- £7 * *■ 3 ,
u &frust*sA j&bi>%*4 w/ /v (%.r r ArtA* ^*•*>»
^ doLr^r^ -£$4y' M G- C4**ffo <*4&/•/*- —' J
s£i+--r\ wrr fuu 4 A u /**• J&*m&
f/hl< fiPrite' gSs'.fr / //, /, / ^ USA'^}
f}st/'L-£'t--*r~ 'ttt ■ t) i'l&p Al t* /jjjlji* /,i t /- —
, 'AkA'p-t^Sf iAdsP **—* 1 ds i t* P (A ('£ l * C-j ^ ^ 1 I
iI&Ca,^ (a C-b(. P*A /,
fict-isjL'j £ LYaAJ^ ^ A
/)h£&1/J/aa^ 0> 1 ^
/?./.
L V*
fhX> j ^4Tt c<"
* , c^-Ar ,/y ~
i <oJu . £w
G* ^
/w^v f\&.X'tr G wn>v»wr ,
% u <4 |:Hu v* *t«vtefe h^ c7 cuO-OO
d 4 @A\*4J l^r^t^ivv Gk/sJr $,vw^v Of \ <A /
fl ' v'ivUvAy b£*CXs , 6C^r (j&O Jl (uY\
{i kilji/S; y ‘0)0* I'L&ifst' teOxO. j&Ccjo
JAyi‘ Jp+V- — fzyAy, /W $A , ^'do£'- fl-tCA f
01 I'W'j'- •“ 'OjX&l cO^ Pt, A & i ^ £■'/,/
,v*» OA **> t/Vw t/ f •*
if, jfttfK O^yvg) (juCT? 7/vt '■ "■ n-^v <>vc/ ^ J
^ W* -v^d- +~ bt£kM K *Ob hrv^ Y £,00}
P&l'J-CrJL «*n^ (Jti 6 /Ttvvl) $U/ l ft>
&*\Xv f $ fO^Y ^ ^ .U v J xfi
fcyb |>zy tc-Vy * ^) 4 ^
, ($JLfO 0 y ( ' \ & L fr\*Y —••
J XjtnJvuU* U> L>+U* l^ '} C/UU\
If&CAZ &ct{ Cb*~Q pktCuJr/ 'fr Z&fis' V d^
h CfwuU Uhj> J tkc^pL c^OJ0> LdO
•1 [Js+'A 0 GrtOd lu*Xu, * ^ *A % (ylj
fdr^y M^ iLrl/y ii ^ f ,4 fciOfr ^00$
IKtA.*' iV *$/(* frJj ( ^ b<* ytkkvx^ Glffio \/s0\
fl CU f ^ Om ^CtT 0 V ,'..
^ f fey /firU (' kj^^JhJjs ycLCiv^^L
/^Uy 'EGA lfrtGjcufritO) OGYc jc hoJLkfoO rtA ^
/tfjpt iOvjp^lh fl j-'f).up’ iaajjOOO (fatOydOw
(m 0) J Gl'y- iC Zf'l . Ot ~~ Ow<*'lO
C^tGuyC tfayCIth i ' u ^ -—•»s/.(
% Vz ( i f OG fa* ki»& cp xO m O tfaplOxdj
^WvC^v [t-(X^V *U fft'V^'^ 1^'V <X-!;ff\j
fh/ ^r
( 135 )
Dangers of operation —Wound of vascular lining of membrane giving rise
0 eflLIs,dn of f in J^y t( > tbe chorda tympani, and to the malleus.
Mode of operation.—A simple puncture by trocar, Astiey Cooper^ opera-
tion ; by caustic, RicheranTs; by drilling with a quadrangular perforator,
Buchanan's, Himle’s, &c.
OBSTRUCTION OF EUSTACHIAN TUBE*
Forms —1. Partial. 3. Complete.
-Inflammation, acute and chronic; extension from the throat of
such diseases, as scarlatina, variola, syphilis, cynanche tonsillaris, enlarged
tonsils, descent of nasal polypi*
Symptoms.
Diagnosis .—Kay be confounded with deafness from other causes*
P rognos is Fa vorab 1 e .
Treatment . By reducing existing inflammation—by constitutional treat'
ment, if the cause requires it—by dilatation, if stricture exists in the course of
the tube.
MODE OF CATHETERIZINtf EUSTACHIAN TUBE.
Instruments used.
History of the operation, —First performed on himself by Guyot, a Post
Master at Versailles, in the year 1700, revived by Itard, and materially im¬
proved*
Indications for its use -1. An important means of diagnosis. 2. To re¬
move mucous or blood from tympanic cavity or from eustachian tube. 3* To
dilate a stricture, 4. To stimulate the nervous system of the ear.
Dangers of the operation -1. Inflammation of throat, and catarrh of the
tympanum. 2 . Emphysema, 3. Rupture of membrana tympani. 4* Strangu¬
lation.
Mode of passing instrument.
Aij- press.
NERVOUS DISEASES OF THE EAR*
Arranged under two heads, 1; Disordered function of the acoustic nerve.
2. Disordered functions of the nerves of common sensibility and motion, or the
tympanic nerves.
1* Disordered function of the acoustic nerve.
Division—!. The excited or acute state. 2. The torpid or chronic state.
ACUTE STATE*
Causes *—From local affection—sometimes sympathetic with general health*
or some disorder of brain, stomach* bowels* or uterus—from over use of organ"
Symptoms -Tinnitus annum, deafness, an annoying pulsation synchronous
with the heart.
Diagnosis ,
Prognosis.
Treatment .—The removal of the cause, administration of tonics, alteratives,
counter irritants*
( 136 )
I* TORPID FUNCTIONAL DERANGEMENT,
Age most liable.- —Old age*
Causes ,—Over excitement of organ \ severe constitutional disorder &c*
Symptoms.
Diagnosis .*—May be assisted by the absence of disease in the external and
middle ear, by a want of perception of sounds when the cranial bones are
thrown into vibration by a watch.
Progno sis .—XT nfa voi able.
Treatment .—:Attention must first be paid to general health; various nervous
excitants, as electricity and galvanism, may be tried* Application of setherous
vapour is recommended by Itard and Krahmer.
Mode of introducing vapour.
II* FUNCTIONAL DERANGEMENT OE TYMPANIC NERVES*
Synonym .*—Otalgia or ear ache*
Causes.— The common causes of neuralgia; enlarged tonsils; any local
disease in the vicinity; direct injury in sounding the membrana tympanij or
eustachtan tube.
Symptoms.
Diagnosis*
Prognosis —Fa vo rab 1 e *
Treatment *
FORMS OF DEAFNESS.
DEAFNESS.
Sy nony mes .—Surdit as , c oph osis*
Degrees -1. That marked by impossibility of hearing at’all, usually con¬
genital and a cause of dumbness. 2, By power of distinguishing certain sounds,
as the pronunciation of the vowels, whistling, he.
Causes .- — Mostly congenital, sometimes acquired. The congenital cases
most frequently depend on morbid changes in the soft parts, in a small propor¬
tion of cases upon an anomaly in the structure of the solid parts.
Diagnosis.
Prognosis l —Unfavorable in congenital cases; more favorable in acquired
cases*
Treatment.
HARDNESS OF HEARING*
Synopyttye, —DysGecia *
Definition ,—Where the faculty of bearing is so diminished that articulate
sounds cannot be heard without the assistance of some particular apparatus*
Degrees. —1. Where the individual cannot hear a distant noise, and espe¬
cially high tones, but can perceive articulated sounds when the voice is a good
deal raised. 2. He hears and distinguishes both high and low tones, and also
words, but only when the voice is somewhat raised* *
Causes .—Either some alteration in that part of the organ which serves
jjMs Has ^ 1* c <•
f^LtiZo^^rr: rtH &V
^ "^22^ In s* /? * ky*C'-G&* / . ,, .
* JUs&t f ■/- i/hwQ^
/%/*'*-'£ Jtr't «rfi.{!, X «r
*-fa, ^& 4 fhs#st>' &yc h(Q tvn^y £t ^
fi^U^C /*+ fi&* <346+* , £/«** >« ^
JAfn#* ^ /Him $/h\A€-L^ ,
( tcru/Jo V &
La^ Qsyjttir >u& ( Ar ; / : >v A . x]
^t^CVOtv/» J2vu /&#*< €-■'£• t- C ' : ,J
A^AvUip j&04...41± '/( J^i f \
j> fivtstf * d-to-iS*/< /?Cc A**** J
ArtoT>~ pb^.- jt/A-t- .An//,. ■*<%.. /
yltfliic* /m*>ut'r: n^- y K& ■ CUy h t L
^ &£u*A- Gt*/£w-£« /*y
/i-L-^i &/Auxya &$ &*** <*jb^C ',&■*■ ? A t<? i
~ /* Ottt ‘*-*-*J' » * In* (f#-yt yC>
£>t As *»*- tiTi't-h- gy '
5“ Uty;..<S — Jul^A' <A*JxA * * *6 J
^8*v^ <2vt^ $C.t*€l-4c. T —
/ ' ' ' <' - l*{-/*/* fr*-- f ( **" _ ‘■'“' *^' 1 * r {,*•.■''*' ■' ^p^-
r $XsC^£& j ti'‘<~sf jtf'tdt. <i- f f&tfy . r 2d£&& /&} ^ i L C,
ifcrpyj errtJtr t tfc 4 4 0*6-& P+u 4 ft*
Hr ^?’, /-
^ 'i
/ V
t- i
l/ x ^ ^
V r !; fj ■ /
y ' v|^| %}aL& $1 \A
C$ &U/Tt\s Cioti^ fjfrtsts- «-*£
gp^ A 0 )T%f£)
£uot,t) uj/- — j& yd <*a {L&h^tj/feiZjU*
^ O^lvUEy^ ,?14 frUyb-'/ifaj ~ />~*<*0 j- ‘o _ • ‘^ >> *- ‘'
I' j&gx f itCv/^+fJ+3 /J
f‘
Jht6 ^C\./d-vbXtJ ltA> i/7,wV Ofi^^t-j <^7 *i-*<a-ou>
/^ <? i*v£t&v \ .* -v /. f» 1 , / , ^ 4it^ >«,.(.
~ttxb ■ff^LL AyC r»*^i>-t_-<J
/w* ..
Lft-. ^ i&iv Uc4 ft- 3 *u>
iY&je. &hX^ tVj 1 /* i»»u.. sh\.£-f fUtv^C -i -—-
<if(U£d:. WV tO j^^Ci^c*^> I j*uA* fl*'If . X<si;\
P^W^yia^w, , 'jz&svvd /va J 'htfltn.s ~tiOs /^/ v^to
OL%t^ jz&A~ £t cc f^^u j^v^C ^f~vw^c- {
^n<-'*it. u<.c£l\^o> jok'faUs cy ^ Mi^C'ii, f ^ ft)
pk.it -j Mu [rt^cic^ ' -£t(j fais , A fti/nA^coit^
IV * /. / _
V’^’ - ~ ss "« / ^ ~
/t ^ /K^ - —■ 'Wt /o<> j
AAjCtte-U'- _ $l£l<se<Y> UslAs <Lict\
JLtrb^ ftd: C&' liai > t*~{/ t &f£e)s 3 Crr 4~
fait txsCL tlx) /1 -m)
Ixa£/ (LtituZc, ti^y t _ i- &1X4. C,
L, a
L'l^et-C'^ A)
**
•2 vo^r)^ LuTt- ^ v — ,
l&ruv i{j
^\y ~ y~y*rj ~ ~ ~ ’ ^/ ^Vv^/,
l**' ( ^Xi^ ~ p i\{f-C4 'f 1 \l>Xs &l p
/jfvusis fitly i/rvu-fisurt 'y^xMy (j~<- fact' (/v ttatfcf'h
l/ j / \vi-' lv< ^' Ia'-L'U, h^lptuko /VKfV«>
|; frOOj j'ivv ^fA- i.o \,lQ, {~~~ etv\s~d T-ts-'l*- _/Q^w^
dy^i^ll^f IUI t /Uv f>t*)A'~ ^
-fe*- fltxiJo /i,u CC*l£U j -~~~i/ fcu ft /[rrn.-£. \st*-' Ax |.V\
bfl ia^Jo /V-t6i- 1HU i.vtT^'- aJxd-x-j/U^)
fluj) jj-fa* (j^wr U)p CL'2*> j^y fff> h'-yy^A
k
<
__ * /si-
Ws6it
*4t*
>e
hiM-d*] £*~*<u*
~Pu
'£'lr
(Mr fT 1 *-*-'- Sd-tt-cA- &Z 0 Lv\s£s
farfiy ck, A^ef^Cc^ — -
^fa/dc / igU*^ ^5 G*Z*£f
A t ^
d/) £e<}~- ^ 7 - *<?
Ax ^!^vti Vv tw.
fan^’J, tZ^^Cy /t\rAS*r¥-*£3C**r Mshcvfa
C\/r'*is1r*F Jlj~&ir 4 £
Q^^cJ^js &S(srnS~
’j-fttlfai LC tf'rU- 'Mt : h \j/&h^S x <s C <
<Ua C/IA^ CMssCr-** c /
fpsCfP^UC^ — ‘YVJ^ dh-'C’C^f' S^£
/liTt*rL£ T, /•^v#' €
/m^ / sfd^-sPL^ ^ $c^2~7P
—* £/ jjJLty, My?'-' ^ 6U*f*Jcr:
^y~~ Pfcc hC^* 'tz.*,/&<J ^--g)
-i'&t'CSX
~£si~ y.. S Cy/r U t C
_
( 137 >
as a conductor for the vibration of sound ; or also an increased sensibility of
the acoustic nerve.
Alterations of the conductive parts are of two kinds; 1* A total obliteration
of the meatus auditorius extern us; its imperforation, or complete absence.
2, A diseased condition of the tympanum, as inflammation of its lining mem¬
brane; caries of its parietles; and collections of blood* pus, or other fluid in its
cavity.
DiagnoHs *—Of some alteration of conducting parts, may be assisted by
the patient only hearing when solid bodies are placed between his teeth, while
his dull perception of sound does not appear to be less when the ear is covered.
Of some disease of tympanum, by the history, or by marks of previous inflam¬
mation.
Progn osis #— U: nfavorab le «
Treatment.
ALTERATION OR DIMINUTION OF HEARING#
Synonym *-— Paracusis#
Definiiion . —Where the faculty of hearing articulated sounds in the natural
way is imperfect for want of precision.
Causes*-*— 1. Alterations of the membrana tympani from congenital malfor¬
mation, or from thickening, ossification, perforation* or laceration. 2, The
lodgment of fluid in the tympanic cavity* as in some cases of obstruction of the
eustachian tube* as in some new bom infants, 3, Alterations in the membrane
of the fenestra rotunda, such as its imperfect form, its erroneous situation* its
thickened st^te* &c* 4# Depression, or excitement of nervous influence* the
natural consequence of the patient’s sensibility#
Diagnosis*
Prognosis.
Treatment*
V. INJURIES AND DISEASES OF THE NOSE.
■WOVNJJS.
Varieties , \
Causes.
Symptoms*
Diagnosis*
Prognosis*
Treatment*
FRACTURES OF THE OSSA NASI.
See ** Fractures,
( 138 )
Definition.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment,
EPISTAXIS,
ACUTE INFLAMMATION OF THE SCHNEIDERIAN MEMBRANE.
Causes.
Symptoms,
Diagnosis,
Prognosis.
Treatment,
CHRONIC INFLAMMATION
*
WITH THICKENING OF THE SCHNEIDERIAN
membrane.
Causes.
Symptoms*
Diagnosis,
Prognosis *
Treatment,
. •
Causes*
Symptoms,
Diagnosis.
Prognosis ,
Treatment,
ABSCESS*
OEDEMA OF THE SCHNEIDERIAN MEMBRANE,
Causes,
Symptoms,
Diagnosis.
Prognosis.
Treatment.
Definition,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
OZffiNA,
' ■
- ■
1
-
-
( 140 )
Color*
Termination*
Division— Nonmalignant. 2. Malignant,
1. Or nonmalignant.
#■ The vesicular.
b. The gelatinous.
£. The fleshy.
d. The fibrous,
e. The hard.
3. Or malignant.
ft* The cancerous.
b. The medullary or hasmatoid.
e. The schirrous.
Causes *—Of simple polypus.
General Symptoms +
Special Symptoms —Each form is characterized by peculiar symptoms.
State what these are.
Causes of malignant poly pits,
Special symptoms in each variety.
Diagnosis of polypus tumour .— Has been confounded with a great variety
of diseases, viz, enlarged turbinated bone; inclination of the septum; disease
of the nasal bones ; oedema of the mucous membrane; chronic inflammation ;
abscesses; ozoma; fibrous tumours of the nostrils; polypus of the antrum ;
hernia cerebri; foreign bodies in the nostril.
Prognosis -Depends on the form of po^pus.
Treatment —Varies in the different species of polypus.
EXTERNAL POLYJPUSh
Definition.
Causes.
Symptoms.
Diagnosis .
Prognosis,
Treatment.
Diagnosis .
Prognosis .
Treatment.
LOSS OP NOSTRIL OR THE ENTIRE NOSE.
See * ‘ Rhi noplastic opera tions, >»
f
i
>
-———— 7 --—
/w ^ ju^r/
i , e^y t» ■ /v&vv-t- jj-r ' * l ^ C\~?£ Jy ^* vv -j l-*y'^' i Vy~\>
Ir-nvO (^x.Zt'Lvriviti
Otv^'C On. jZas—cs - C, Jlp-sCfa,
Cis . /]>v-c ^ *n,<JLc+^ >
(fc> Rl
bo isfiriu £-(”->
d/’t'i' jdfrisu &0~i ^ ^
(<^V /&
C 141 )
VI. INJURIES AND DISEASES OF THE CHEEKS.
WOUNDS*
Varieties ,
Parts liable to be involved.
Prognosis.
Treatment.
TIC DOLEREUX
j Definition*
^Causes.
Symptoms*
Prognosis*
Treatment.
Causes.
Treatment,
, SPASMODIC ACTION OP THE MUSCLES
Symptoms, . /}
Prog-no s is* **
it* if
mO
Paralysis op the cheek.
Jh-yt VUv* P ^
Varieties.
Causes.
Symptoms.
Prognosis.
Treatment,—l* Constitutional. 2. Local.
1. Only required when the defect depends on a constitutional cause, and
must be modified by the nature of this cause.
2. Or local.
V
a. Blisters.
b. Application of strychnia or veratria.
c. Electricity.
k d. Acupuncture.
e . Excision of a portion of the cheek.
f. Section of the antagonising muscles. (Dieffenbach.)
h * "tumours of the cheek*
Varietieh^^ ^ \
Mode of operating in each*
ULCERS OF THE CHEEK*
External and internal.
Varieties*
Causes. *
$8ymptoms*
Prognosis,
Treatment,
( 142
MACULiE.
Varieties.
Causes,
Symptoms,
Prognosis,
Treatment,
LOSS OF CHEEK.
See « Chieloplastic operations,”
VII. INJURIES AND DISEASES OF THE JAWS.
FRACTURES.
See ** Fractures.”
LUXATIONS,
See “Luxations,”
Varieties,
Causes,
WOUNDS.
Diagnosis,
Prognosis.
Treatment ,
inflammation of the lining membrane of the antrum.
Causes.
\
Diagnosis,
Prognosis*
Treatment.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
ABSCESS OF THE ANTRUM.
f *+
Opuses.
Symptoms.
Diagnosis,
Prognosis.
Treatment •
ULCERATION OF LINING MEMBRANE.
'a'jfeSt:
(bt£ y *^C *. -fj $3&*%jCLp
■ATa. ?</%&
■£
$1* tte^tSA erf Aa.-*. -££c^~~- -/j &L £nrf~^A>
£t*s-£>^7 tfl- tb /£
*
.
.
■
v ' % *■
1
J
*
/
/
«
( 143 )
Definition
Causes.
Symptoms.
Diagjiosis.
Progriosis.
Treatment.
SERO-CYSTIC TUMOR OF ANTRUM.
••
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment .
FIBROUS TUMOUR OF ANTRUM.
•
Definition.
Causes. ^
Symptoms.
Diagnosis.
Prognosis.
Treatment.
t
FUNGUS TUMOUR OF ANTRUM.
r»
% *
POLYPUS OF ANTRUM.
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms.
Diag?iosis.
Prog7iosis.
Treatment.
« • c
BONY TUMOUR OF ANTRUM.
g
f g
FOREIGN BODIES LODGED IN THE CAVITY OF THE ANTRUM.
Varieties ^
Sy?nptoms.
Diagnosis .
Prognosis.
Treatment.
Causes.
Symptoms.
Diag?io$is.
Prognosis.
Treatment.
• OSTEO-SARCOMA OF UPPER JAW.
/
__ I
Ji) Afol'Wi'i'* &w$ , l^/UobtsV (X&Amj* •— Av yl~kssix^ y ' //:
(TO- !
/( £ -<- Ct,
r hriO !o &i r b*- < j4x- /h\Ct.j tuAM
I. ■hsjwAAHd ^m /c-C C- <7 ffit’VZZJ el t *■(■ v 4 -f-(\
[ /ttyOyvfJL s!>\\fa'(- / i l L/flu }iL rL& tc <f ,
V H .
| jfi bhtirfT&^C t >u d^Yc : t-C^L &y //*• y / ^ V// jv / r ^ r "
*7 / CJlcn /1£ 7 &t^{rUf+*-<6 av /< -*W. ^ —
J.-Ju itXiTt >. A A K t it. cuu £W6 CU 1<-C C /T et- 4 -C
7l< js.fti. tt/ti-i ey ^fi&frZ-* /tru/ct r / , y■ >< /x-t-i-d
Upu. Ai siy/c<?C • ^t- /^L~ Xl^?
I (^£~ f.ryip-t-.£^ /Tvc e#y^Zrj^c Yiz/i / > A 7t-«
: PKft >?v Oskety 4^7 is} p-f-c^ __ lukJi\
hj-t trZ &-> /^U 1 fatfCc-t- Ay c * i ^ ^>ty^
j£iAY&*t4, ^ e *k~^ r yd^f
/'fr . Jsf\r «I ^r^i, t, ^ ^
* ySy ?// C ^ x - £-*■ *>v *^v y A.
tc.^',
/■Vi-
^/A 71-^cl' — ^
Jle + <-^<^ J'YtyC* -^7
^ ^Ly^d/redct-JcTys v, JcA^'C y. c, (r —
£- odA* l/ / Jt-cft \Jyc £€~*- t
c;. -t; \i< c £ ^ it f—i y*—A~y yi- / /h~^sL\
rj^Cci- y — Jp
f C laX-r ^ Y
f^/ysrxT,
tde^L^< £- St'Ats* £^ 4 - i’iri t-C- . ’ ,^/j-lX- .
7 c .-' ' ' ..• y < . *— • V-
.^ -/-<£^'? C&'jU''/- ’■$*'*-& X<-w, <i
Jj/j./ruC' y<f'kyd{/l- C'^H-',;- ,4 4 , j UM i
fr^ Ut cX /> * l r '~ "\ i^Cy/^y^J //. / / A-7v t|
_ c^p c C<!< s- 9^*X f ^ (to. b f-<: ’ |
4 A x-'/. (C ji- 7/w. .^* s ^,.7/‘x-xJ
r j-d-'o'
7_ .;7'«''-
^ >' J : ^ v^t ^
'UMfrl
'■ / , / j -■- .' '• ! -- 5 •
i^Ct-4
. at /? (K/,
r&TLtTL-t^A £ ' '-fifSt t < <■£
' /:t*r' '3—&t.Or rf^t-Ce.
fa inut£. 7 &k*&*/*.'£&. * fa?;„ rn. frcd
fty± CLt~UM^L**-0 — Ct*Lii -/<~J <J/t sy, i ■ 4', J.> '< t Jj
I £s?? c j /vv €j&*> yxv / . «- c f-*** fa* <r> 1 * *
jCtC-C^L. ± <-p* CyZ ZX_&* fj 'Z "t
a+.t2 &i.^v u^x/xZuj i^y __ 4
2^U- &udu » <&■ *&£*& ** /C-<-~ <r^ c*- g r * <£.
^ tC<t£ fa A -
/V,'
^CU*y^£ 6& -,' _;.> f .j£ faO-*^. 'Ui-Qjj
) ' ■- v i'vJj ..__ '/'■ . ■eZ't'Z
€&tAi£c / ; -f
VcfatfaCfa-O <JfaUMA~mA*J' p-hfajj- (kfcu* V Cj
tfaTP*- °tyn4'Cd* t l*f\‘ Zjf Or- ; fyl t ■ —
( 145 )
PA RUHS*
Definition *
Caus e $.
Symptoms r
Prognosis*
Treatment.
VIII. DISEASES or THE SALIVARY APPARATUS.
I. DISEASES OF THE PAHOTID GLAND AND ITS DUCT
TVWNDS,
Varieties.
Causes.
Symptoms .
Prognosis*
Treatment.
INKlammatiox or ths; gland.
Varieties -Ac ate and chronic.
Causes.
Symptoms „
Treatment.
Causes*
Symptoms
Prognosis,
ABSCESS OF THE CL AND.
Wfyr c '■
Tern OUR OF THE OLA NIL
3. Fatty,
d. Melanotic.
c. Encysted.
d . Fibrous.
e. Simple hypertrophy.
/♦ Erectile.
g > Aneurismal.
/t. Swelling from salivary concretion.
A Schirrous.
CWsStf.
Diag-jswm,
Treatment .—In each variety.
10
( 146 )
TUMOURS OCCUPYING THE PAROTID SPACE.
Varieties.
Causes .
Symptoms.
Diagnosis.
Prognosis.
Treatment.
WOUNDS OF PAROTID DUCT.
Varieties.
Symptoms.
Prognosis.
Treatment.
FISTULA OF PAROTID DUCT.
Varieties.
Causes.
Symptoms.
Progjiosis .
Treatment - Four methods. 1 . Cicatrization of the Fistulous orifice. 2.
I'.latation of the inner portion of the duct. 3 . The establishment of a new
opening in the mouth, or forming a new portion of the canal, where the original
^ een destroyed. 4 . Destruction of the parotid gland.
Agents employed under the 1st head_
a. Suture.
b* Cauterization.
c. Compression.
d- Plastic operation.
Agents employed under the 2d head_
a Seton.
b. Probing.
Agents employed under the 3d head _
a. Operation of Deroy.
“ Duphenix.
•* Monro.
“ Tessard and Flajani.
“ Atti.
“ Deguise.
“ Bonnafons.
“ J. Rhea Barton.
“ Horner.
Agents employed under the 4th head_
a. Pressure on the duct.
b Ligature of duct.
c. Pressure on the gland itself.
b. tt
r. a
d. ((
e. ti
f.
g- “
h. «
t. CC
■
m
■
' ? ^
V* • ,-..J, *
-
n ( 147 )
FISTULjE of parotid gland.
Varieties. — T wo .
Causes.
Symptoms.
Prognosis.
Treatment - a . Cauterization.
Suture.
c. Excision.
d. Blisters.
e. Gold leaf plaster of Malgaigne.
II. DISEASES OF THE SUB-MAXILLARY GLAND.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
WOUNDS.
FISTULA.
Causes.
Symjjtoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis .
Prognosis.
Treatment.
ENLARGEMENT OF THE GLAND.
III. DISEASES OF THE SUBLINGUAL GLAND.
Causes.
Symptoms.
Diagtiosis .
Prognosis .
Treatment.
WOUNDS.
FISTULA.
Causes.
Symptoms.
Diagnosis.
ProgJiosis.
Treatment.
( 148 )
Definition „
Causes.
Symptoms,
Diagnosis,
Prognosis,
Treatment.
RANULA,
Causes.
Symptoms <
Diagnosis.
Prognosis.
Treatment.
ENLARGEMENTS OF THE GLAND*
location.
Varieties.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
SALIVARY CALCULUS*
m
IX. DISEASES AND INJURIES OF THE MOUTH.
Varieties.
Causes ♦
Symptoms.
Treatment ,
I. AFFECTIONS OF TIIE LIPS.
WOUNDS OF THE LIPS*
SIMPLE TUMORS OF THE LIPS,
t'anmcs —Encysted, fatty, transparent cyst, enlarged follicles, verruca
moles, &c. ke.
Causes .-—Vary in each form.
Symptoms , — Depend on the variety.
Prognosis.- —Depends on the kind of tumour.
Treatment . — Varies with the form of tumour.
w
.
■ ■
K-
*' . •
*
.
.
Points usually attacked. —Margin, and especially that of the
Varieties .—Superficial and deep-seated.
Causes.
Symptoms .—Vary with the stage and form of cancer.
Diagnosis.
Prognosis .—More favorable than in any other form of cancer,
Treatment.
CANCKmr ORIS*
Definition.
Persons most liable to be attacked.
Causes ..—Constitutional and local.
Symptoms —Vary with stage.
P rognosis , —nfa vo rab 1 e P
Treatment ..—Depends on the stage of the disease, the part attached, and the
situation of the patient.
EVERSION OK DOUBLE LIP,
Definition.
Causes.
Symptoms.
Prognosis.
Treatment.
HYPERTROPHY OF THE LIPS*
Definition
Causes.
Symptoms.
Prognosis,
Treatment.
ADHESIONS OF THE LIPS.
Causes.
Symptoms.
Prognosis,
Treatment.
HARE* LIP*
Definition.
Varieties.
Lip most frequently affected.
Compl i cat ions , *
Causes *
Symptoms.
Prognosis.
Treatment .—Depends on the age of the patient and the nature of the defect.
a. The tfsual operation.
h. Barton's curvilinear operation*
c. Malgaigne’s operation,
d. Operation without needles*
( 150 )
ATRESIA. ORIS,
Definition,
Causes.
Symptoms.
Prognosis*
Treatment.
mouth too large.
See Report by Velpeau of a case where the mouth was open nearly to
each ear.
loss or lip.
See ££ Chieloplastic operations.”
IL AFFECTIONS OF THE TONGUE.
WOUNDS OF THE TONGUE*
Varieties.
Causes .
Symptom t.
Prognosis *
Results.
Treatment*
Definition.
Varieties —Acute anti chronic.
Causes.
Symptoms.
2 y rvg?iQsis.
Results.
Treatment.
GLOSSITIS.
H TPERTRO PH T OF TONG UF.
Varieties. —Cob genital or acquired.
Causes.
Prognosis,
Effects on the bones of the month.
Treatment.
a. Remedies calculated to promote absorption.
h. Pressure,
r. Ligature.
ft. Scarifications.
e. Excision.
( 153 )
TUMORS OF THE VELUM.
See “ Warren and others.”
Varieties.
Causes.
Symptoms.
Prognosis,
Treatment.
INFLAMMATION.
Varieties - Acute and chronic.
Can te ?
Symptoms.
Prognosis.
Treatment.
ABSCESS.
Can scs.
Symptoms.
Prognosis.
Treatment.
ULCERS.
Varieties.
Causes.
Symptoms.
Prognosis.
Treatment.
CLEFT VELUM.
Varieties _ Vary in extent.
Causes. —Congenital.
Symptoms.
Effect on the voice.
Prognosis .— As regards a cure by operation.
Treatm&ts — Operation of staphyloraphia.
FISSURE AND OPENINGS OF THE HARD PALATE.
Varieties.
Causes.
Symptoms.
Effect on the voice.
Prognosis.
Treatment _ Operations of staphyloraphia and staphyloplasty.
( 154 }
LODGEMENT OF FOREIGN BODIES IN THE FAUCES.
ENLARGEMENT OF THE TONSILS,
Different kind^i^-Whh. bones, bits of bread, pins and needles P a thimble,
(see Parish,) &c.
Symptoms developed by the lodgement off such matters*
Treatment*
location off the gland*
Structure of the gland.
Different kinds of enlargement *
a. From acute inflammation*
h. From chronic inflammation.
£ From contagious inflammation, as is seen in angtnosa pntrkta*
d. From closure of the orifices of the follicles*
e. From inspiration of its secretion.
/. From calcareous deposited*
Persons most Children of a scrofulous diathesis.
pauses -Tar y with the kind of enlargement.
Symptoms.
Effects on the thorax—^ see Warren*)
Prognosis.
Treatment .—Depends on the kind of
a. Cleft uvula*
b Hypertrophy of uvula.
c. Enlarged uvula.
d* (Edema of the uvula,
e. Relaxation of the mucous membrane of the uvula.
Causes in each of these defects *
Symptoms in each. *
Prognosis in each*
Treatme?it in each*
NECK*
Causes.
Symptoms*
Prognosis.
Treatment*
WOUNDS*
AFFECTIONS OF THE UVULA*
( 155 )
ABSCESS*
Varieties.
Causes,
Symptoms.
Prognosis,
Treatment*
ULCERS*
Varieties.
Causes.
Symptoms.
Prognosis.
Treatment,
TUMOURS OP THE KECK.
Varieties .—Sim pi e and malignant.
Causes.
Symptoms.
Prognosis,
Treatment.
HYDROCELE OF THE KECK.
See >< Maunoir.”
Definition,
Causes. ' *
Symptoms,
Prognosis,
Treatment.
BROKCHOCELE.
Definition _Tumour of thyroid gland ; from e% the windpipe.
Syuonymes -Gotre or goitre, tracheocele, Derbyshire neck, thyrophrasia,
&c.
Varieties. —Simple, complicated, and malignant—(see N. R Smith )
Age most liable.
Countries in which it is usually found.
Causes.
Symptoms.
Diagnosis .—May be confounded with other tumours.
Prognosis,
Cornedimtions .-—Often with disease of the heart.
Treatment.
a. Iodine.
h. Mercury.
c, Frictions with various liniments,
d. Operations of various kinds.
1. Electricity. 2. Caustics. 3. Seton. 4. Tapping when it contains a
cyst. 5. Ligation of the thyroid ar ter if s 0. Extirpation.
examination of these different operations.
( 158 )
Causes.
Symptom* *
Di>tosis.
Prognosis.
'Treatment.
ABSCESS.
exostosis of cervical vertebrae
Symptoms*
Diagnosis \
Prognosis,
Treatment *
tumour®;
Varieties ,
Causes.
Symptoms*
Diagnosis.
Prognosis*
Treatment*
ULCERS*
Varieties*.
Causes .
jtttagfH-0.** j.
Pfograotfaj.
Treatment.
LODGEMENT OF FOREIGN BODIES*
Nature of these bodies.
How introduced.
Symptoms developed by their presence *
Prognosis.
Treatment -Various means, and as a last resort pbaryngotomy or aso
phagotomy.
DILATATION OR POUCH OF THE (ESOPHAGUS.
Can se a .
Sympto ms *
Diagnosis,
Prognosis*
Treatment,
( 159 )
STRICTURES OF THE (ESOPHAGUS,
Varieties. —X. Spasmodic. 2, Permanent, 3. Simple, 4. Malignant
cancerous.
Causes.
Symptoms.
Diagno sis .
Prognosis,
Treatment.
SPASM OR NEURALGIA OF (ESOPHAGUS#
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
PA HALITS IS OF (ESOPHAGUS#
XI. INJURIES AND DISEASES OF THE THORAX.
WOUNDS#
Varieties _'Superficial and penetrating.
Causes.
Symptoms.—\n each form.
Prog?w$i $. — Depends on nature of the wounds &c.
Effects produced by a simple wound of the chest.
Treatment .^In each variety.
WOUNDS OF THE LUNGS# ‘
Causes.
Symptoms.
Diagnosis.
Prognosis*
Treatment *
HERNIA PULMQNALIS#
Definition*,
Causes.
Symptoms,
Prognosis.
Treatment.
( 160 )
Causes,
Symptoms*
Diagnosis.
Prognosis.
Treatment.
WOUNDS OF THE HEART*
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
WOUNDS OF THE INTERCOSTAL ARTERY.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
EMPHYSEMA*
EMPYEMA—HYDROTHORAX—HYDROPS PE RICARDIE
See “ Chapter on effusions. ”
Causes,
Symptoms*
Diagnosis.
Prognosis.
Treatment.
CARIES OF THE RIBS*
Varieties.
Causes.
Symptoms.
Prognosis.
Treatment.
tumours OF THE RIBS,
fractures of the ribs
See Fractures* 1 *
PARACENTESIS THORACIS*
See it Effusions.
DISEASES OF THE MAMMARY GLAND*
See tt Amputation and diseases of females/
■i^ oXCiv^ 'J^ cu^\JA i/f - }e^!XV>
jLuV tv^fyvv Wvv^*vw iiCU-V J, .y^ i
jviA L<-( ' i^TJ^ dsit/LU*.. fjr t *k ^
fhvi>^*- f\,t l"f A- X'Kv'-K*' 1 * ^ 5 t > »-
t»-
*\
jVKXO-'j 'P* ^ ■
3
l-AV\->
lv* «
V 4 . K * 4 \
b^tu^^’X W'-'-, t /'V *
: - '.j , J:<~\ <U ll-X^
r £ < < / o , £*■ ^ l - f -t'ti. \l~<. ^
^ I si Ik /it.J' t-i-v ^' C^vt-
I lr ^ />_ 4
t A. ■
|xa rs^vv^ y K^ X ,y >(.^r*
^1 ’ .KvV. ■"'" '■|j X ' 4*-^0 !/ ' - ^f <' ( ("W
Llr<rJ.^ l j U&i&Mj u~
1 V ( - ttvr^JXX'; LyW *
f t V ^/-vw ^ jL^-vt? &AA~ VVV-~-^i i K>— {3 { ' ;
•y'*- ><_/*■ ',— K-v
A—
K w “ jr ^‘7 ■*- k |
■. 4 xA-j tv i~X ( 'X - ’^t ; /
Kr * /vX J. XxpX <.v£fc -cJ-it ^
/ ^ t > — J *.
•4 ^,- r ^>v iv? |p<v-. -v- u 7 |. * /Xc./^
f~Hsv~- c*~ 1 ■ ■ ■£ ; ttPfrr i-t-' >- / ^ 1 -
^- //: J ■ /' - Xj:. < :
X
ti
X-X-^jX 4 M/i -i. — X- X<y K
7 t^-<-^y t-'-^ £^L+-C-j ^vi>/" jf~^l t ^
^ - ' 4 *’" ^’ 35 'tj</~ //
y ‘"Z ! >\ ; ■. K\ v A.-.- L y
4 \ 0 U 4 &) .
^VnaWx . y ,k -a.(, ■ 1 •} *■
( 161 )
P
<?CfUL.
' 7 ‘
XIL INJURIES AND DISEASES OF THE ABDOMEN.
WOUNDS.
Varieties -Superficial and Penetrating. .
Causes.
Symptoms in the first or superficial.
Prognosis in superficial wounds —Generally favorable, but may give rise to
peritoneal inflammation, abscess, which may dissect up the integuments to a
considerable extent in consequence of the resistance of the fascia, and finally to
hernia from the weakness of the cicatrix.
Symptoms in penetrating wounds wlhCn no important viscera are injured.
Prognosis in such eases.
Mode of examining such wounds*
Treatment in each form of -wous ids.
Treatment of penetrating wounds complicated with protrusions of the
Causes
Symptoms
WOUNDS OF THU STOMACH.
•v ff t/ t'jji/ v ttva *
BittfptoHi.
Prognosis. «- / V 'W ’
WOUNDS OF THE INTESTINES*
,rOU~
Treatment ,
Causes *
Symptoms .
Diagnosis
Prognosis.
Treatment.
Causes ♦
Symptoms.
Diagnosis.
Prognosis*
Treatment .
Causes .
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptom, r.
.Diagnosis.
Prognosis.
Treatment *
11
0 L
WOUNDS OF THE LIVES.
WOUNDS OF THE SPLEEN*
WOUNDS OF LARGE VESSELS*
( 162 )
BLOWS ON THE ABDOMEN,
Symptoms to which they give rise.
Prognosis*
Manner in which death is produced.
Treatment.
ABSCESS IN THE wklrLS OF THE ABDOMEN,
fZZt'/v r/ntro
Treatment. * ~
TUMOURS,
Varieties.
Causes.
Symptoms*
Diagnosis*
Prognosis*
Treatment*
FISTULA—(BEAUMONT^ CASE, ETC,)
Varieties ,
Causes*
Symptoms*
Prognosis.
Treatment* N >
? U vJS
\ - Varieties. ^
Causes*
Symptoms*
Prognosis .
Treatment.
‘ARTIFICIAL ANUS,
POISONS IN THE STOMACH,
Introduction of the stomach pump*
PARACEXTISIS ABDOMENIS,
See < £ Effusions, 5 *
EXTRAVASATIONS IN THE CAVITY OF THE ABDOMEN,
Fluids extravasated ,
a* Blood,
h* Chyle and lymph.
Bile,
d. Urine.
e, Fceces,
Symptoms produced by these extravasations ,
Prognosis.
Treatment,
C (TH *a.
UA*~ / i'Vv
j v u yiv^-vnj^ * y ■ • 't'V" “ u-.
' [a/^'C- I\Js/. LA O' I t\J~
/Luo U t- ^ v ^ (t\ v' 4 Z i
| $\jL (. i\>v 1*4 'hvi.y'/ f'l J 'd **
£rtc^-e vtWx^ - ^ £/>> 4 - ^ -‘ * ■ ' ■ *'
Vt 11ULSitsCZ^ ^ [ft 0~ld tuA
l' v ^ / *r 1 ^ / t V v * <
^ / /^V |J
J> V '
d~it t~-
/ / t- «— y tft y^Aj
/ "/) r in*/CJ ft A ftj / 7 li 7 • *
/•^u/ L+U</ A , ^p.c><-•; <- /**'!' A^A{\L C /J LA
OlM^c^U l^/n~ / ft*- •
^ />
l ) Ut It
A^li^cA- ’^• / t/S- j " - /
^'v^y <//
/ /
&H. J si ; y(- f t ) A C ‘ ^
^£z_ /H*/ l L.xr . #}"Cd«J (s-%Jfi* \ /’• ( 'j« - ^
ftyft /tiL £t(, > ^*~ 3 ^Z ft srr^t'L &- -■
\ 3 | /li^L -- f - &. ...X I
V- h ^ ^r*, ^hf n / tJ ' L [ i v./)'
'pL.-i
OsK~ A/
, r ' '"" . i~y~~ ‘ r 4 - /
. •• iu*.v M ^ ■ . .'''■*■
*;•• /it , ; ’ - ^' '" ■ *7 - • ■
4-tlCc ,0 j tft LxOtxyC /‘''^-' x y- •y’ , -< •
y i-vy^o^ j^_ v_. tv^. / i \ ' ’
cx)r .t y-. - 4 - -/ / ^ 4 ^ c A 4 rrJ
(/jttri . Vv i • ^
41 - C > '■••-'
0 zh- L-tu.-f.Ar c-y
j\cr~k <>Kf. M. X ^. 4 ** Ix C L ^
/{iuW J ---—-
(fix t'Olr^Th'ViAVf 4/ v 'D^' v ' AkA/J-sJ^s ^ J f\ CtJi
hi'A. M^Cm, QvfjjUcfcifcy J)\iajto jy-ct fjus*.
U/i' fod Vk&^Llu CA> f-^/yVv—
44 tjt|ii vjr ' " U >? '
jh \LiAXi - ^(/i/LAC- Ay'jsi/i* \*'C^(^y
(VxUk' i^tts^cdl, rV y-C fc^ly 'f \{ yv-u,^
\% /I./'VV' • ).l
„rn ^vix'i-'*
^ fy ' - - -- - I - • -■' ’*- ,: '
If ^t r yufr LAjJz?) f}^ /m 11 I
j/V£^J L Yv Cfc>uW-■«• v. t;/ ^ /^-f (/^ feCty'W
t/WC^
J^ ^V( — $Xl U v ^t| ) C c (X- “"
- 7V\iZfwfA<C _ f)jU-i| (Jt/VM, «*- Pj tT\r&-AA- CAsvx^
•jftywU-X'v 4 ' «3^C£U-^ <p01/&k ryZ-Cdt-ii^ LxJr- /[X\^
y X-( 7 '~Hs - rh'-tf' cv^ ^I-Cl
U'i C L til\JL. - /'/ (a {.■ - ■■_ 7 t. {. <^lc XudJh/-'
,{.\^)jU*~\x l _ he a~£{f;i: - f& jif V ty-O U) U
W^J* (r Ui/c*-ij - w ^ v ^- / {/'l s/J^ l A. x
W'' "-ft L V 4 \ 4 ,w >W - : ^ u , $C'U&tL 14 & suii\
' ^ W £ <>X — - <J< 4 / 0 ~ - V<
t<J
. » - - - v '. CL IXLUaA
I - £t"t-i^ <^l'-£'t hut-iv /TL
i f {P J 1 C—v- CA^— L?"/. \ £ £^}~'& 1 /
" (pjJb <&4'-t^ J L ^. U..4. tit/- to- li _ /for
4 'U-A^ / ''*Ml. vl^^-w U . 1 -.^ — .'='• ;-C- ' <_ J
% *tyyr ^ IMiux r ." - .
^ , M'h^tUA* fj&lw i^-y r lO^yiv^
jtt'CtJ _ avv ^.w/w
‘d-, <h ^ j !; |^ A- I'^'X tvw^ t*v-c A-
fV - 6t>v-X v4 !t6 ^a/V
"fev) ^TfV-V 4 >tr C{t: v tP\,iAM :\' f rTM*
c r tuTt^vs 6vfi (hr "twf>
j'P jrtX^. vVr c i^U> !jy/vs^
^ tu> lUp^ Ak
aUaC /y[c W ^ O _ ^ vi) Ua /-6 _
fo^txUuA-., Oi fit^ ,• . Tfek. ^ A. I
* / CcAa fuA/y^ py tr=uM
0 U* olZ ('hv&.fcfcU- AvAt cf'L.lt tf~ *&*Jh
fiA AuS& ( t&* sj fv'*-** j // /~i ^
fjkjf-'A y /L €+y ttZuXo AalU 7X. v ; . i,-.yU-i l.
ZmJ^A juAb ALoOA A
C\f-CL.y O'j I'D &l*-*4 J-'Li-&lj 4js~AA 1 • XaA^O^.
oUvJ-'IZL AuZZA £>/Ar A o^A
/k-f r b<s* <J t~~z*A&£-> cA-tkzA* '~/Xc3 ’^Awj&AiAk^
"jAyy At-cykic/y^t-L-^ - A/t-Aui/ ixj ^ xlAl^^ j
^AA-L^h (Tt LC i^n/ *-*--« <^K-^- G^ 4 “j\
A- (%-. <* <><-
'(far k* U-C-(l<. f'CtcJ.c.S Uszr^t--Cl&—~
A~- fiyijs. Hst\*A "y 'C^ i L.
))AAJ < 7 *~ A Us-AxZ' CglAL- 6 L**-<s<' — At A
' <*' * '« t ^ £c<j.c£ uszr^t-Cx-Cr-- , ,
«&^^Tv *ytA-*kt * iF~CA*y*~*y HI
iX[A~ X//t<--c- ‘-i- ^—^S. t_. &c&-'!‘
(A AtXrh^ cK-i'lx. £A 1 'h^^Aj /A
CUA ^jljA /mA^- &
i^cx/ ojtczUA
A j £x~c.<~CJ
ft^~' A-^-tc xucC AC&}t•-<-**•-&■?(* f J 4 ■'/' ^‘t-
j%~ 4 jt-(L ^y- A $Lt.w<yy Ck^
4 /^a^v»vu.v m~A cA - fh.c^£Uj\
^C'ki/A t~Xi *- ji c, y * *' 0 * /^' /■- 4 A c^a. ! XX-G- i ft.
^t/YXj tktsCkA-£t VCKp,
-»■ 4 —
} l ip Tl6Ls\;■■&* U
^tcx^p'— fi c< y _*
P — ^*T itty\As O^y-'d A 4 Lo
(AM'^fvtiA 4 rU * cJaxjl Ust^+Ju cIaAO .
■
tT 0 v Wd-iAw^>t Jm|ir O'- ^a) <y
L
- ' fLy (LxaJ^T ^t L yf *.
(hi£v£c- $JThM^ &(\Ur't; U^zru^^ijb (Jl |) ^
fttecS/, fccofi dpi ' c *4 f A-
£/u. dju^^^cZZ —- ’ ti ^ ti u ( - f / ? ii/ (
fy ^c cHtdtc Li j OckmJt k ttiz kA-C^
MMUU v^ ' /&( ji (A C%t*Ar TZfa, ^V'^vC-
j. • ^axu h /i/\J flytn^f - (Id—-
L^/av^/^ t-'C?-c 4 h —^—' -i
L - ^tuu/C o).
t'VC^C
CU fZ
AA G&hZc+iaL tz£<-'Z 4 - 6 : ' C i
rv^_ ^ » n / y
/
iZ ■ L: ' /_ / A. A/S 3 ^V;f t?, } — _
^C- / ^ -
A*a?W c t/tfc ^risL^Jh
3 ,/
y
t/>
y ^ r <
**>
l? ^ * tf * t t j^ti'-f yy^. *'/f* xjr A- /f~> *-A^
j'J.A fa~> /Ct n f A' t f-vv ^ J^nr~tr\^ t) d^. , ^ tri^ t^>
CA*- ^Cv t-/ - 11 » v l w cA
i Ocl^O^€Ay^ b-i/t^
/ ?2 c 4 - ^ ^ Ktw ^ ■> ~p^ # * * l ci <£- hsc r t
d'-tcy fi t l I WI
ZA
<£ J
£- i v-^ v- Ct- t- ^
/
T r /
^ e<w.J ^ t^iM^A /Hw/Vr
/?- ^ £ i-t vu V
^ ^ i
— c , ^ w ^ A-/--^-‘Wj
■') i-&sitd^-> ( 2 ^^^ J^ i - x
^ ^ /^ A ' I I ^— A- ( j
I'H f ,«A v-^i. <J
i>^<- ,, /.
^ ^ C^j/ 1
U- t^yj K tl-H kT> — (y'Kf^U.I (a^ ^' ;J-.yj
l^^tZ hvZ>(J favfo'S /{ \k: Jl 4<yL
i%tK A« d U Me,, *L ttL ft^rt lL V y4^
‘ ^' ■ “ J n / ly h>4lv /Vl^ ^i W/C
A ] I l , : - t ^ n 1 a i yj J/v 3[/0 ^ jC
f.- iV"^ I ,
t'Vr -Vs*-
<^L $£#n-Aj£c,^ <2-ft+-C * Vl (TiVi **-■ -^S-X—yl.
£< ^O/ ^ e* ^L /rr^c^f / £t c^l%$e* ii v .
^2 _ /4i- l^ ^ ^ f v w / / f r ' i ^ * '
Asz.„£ &<?t t*uy £%
^yr ^i-*- * ^<L-«_ i'<- 3^£ ; '•£'''<"*. «*. £’> ft*,
-*- 4 , «f-*-c^-^- XsJLc* /rv ife - /. ,+ K ^.' , '
<r>-u-
^ ^ ^ ^ ^V’f t* i. ^C ^ ^
f") f /t n u t 4 -h- , ij/ > t »-^w
14 ^ ^ q£^z*-^ lJ- t^j f
d^ZFC-vJ ** ^ ^
JfuC eL*t-c) Ol-i. -'^tX^ (■* * .&*•%*0*^ i*-*~4L..+-j
fez ■vC-O-t <^?.4 j&£X*&]f- *L _ , '_
f'7'-'h'i ~ 2- *- <! t /s£L ^.--^ jLjt-iy'^ t
/^" C>^- <— jP^Z^t - *•■ @ £j~ Ci\^* j /3 £3C*r&.^ Ls' r J- {,- J ** v ^ <*^y ^ (j
j $ . M /
4^ Lr*u^€T% i^.+ V lS<
.^2. £its±* f$-^ 4 ‘ S C^- c * ^ < 7c^
4**--—C £w p/ t_<? - o *^2 y* <^i «/ Ccv^X^ X'-- jj||
/^// Z w 'i-u**t- t ^ 3 X^L^r'
' ^ ^ /^ ^ ^ /z
3 jit.,
U>~&J-£:-XXi £
Av W." “''&*■ U-<) c^- C-. * ^ ! -
(X
<xt.
c
/■ - A
■ .' •.- < >. r
■
/"
A / '^r w
, f ^ ^ £*£&£ 4-£'-t r ? A ~* ,
<7, ^ r ^ c. ^ / X-^ /
S-t^ &tt- p'L^^ -s- ^ c ^ a
. ; /., 7 ,- -- ; ' V' A-Xt iilt
/h7 d :“ ■ ■ « ' 1
A-t 7
.^v k r 4
/^ti) /-
jyt'^ 4> t\^J— —*
^ t- iS- cy / 1 1 ,^_, T 2
/
Jjt oO^ - s'hM-js,. I/) 'a*~
i vh^^Ji -f&v-c- ^ d^&sphV~d*4. -
; i(_7;| J a^j r /— pw-
b^Spt^ JLa A*"br^o& fU*s~ /CL d/EZ-
/f^ix * 1 /s^litAS Lckj )
iAn^oX> (L- '- '-d- - (Pn*><~4
Ci^^L (P rar / $CjL*u!- $ C **■ is&^LstStr
(ML ^cdLL'* ~Jyt,t-te f l4i£si,<i Y^-Ls syyuA/jyfL
JuL- 'G 0^ &) 'i/^vxAj k K^p
'(UHtvC f%+, <%aI t r{ jXv- ,-^uw; 4' ^ A<
V w 'i-efy t pAt) Pv^~ (Li k*v%\sL cl rL^j
^ ~ ? ^ 1 * v ‘ L <-v -
u * $. . -<7 , b-uL p^A A AAVv^C
otoi *7v fee* - / 4 i
v^~” ^HtbiruT^ I i® CL-otc , /#
^vW , W^- rM^'f^
(j|> Jwli-V^O J.V £( . , • A ,VW> A( A ^
Hv[ t^r^v v j pu ^ a Wx/ £/( I&UMmi
I » ^ &•) A-, ^vT“ A. ^ • V tM/f^ UJfaUx)
fti‘ L,\vaJl oo-tfjk f h' ^ 'Q&C*-'}
’ $L ^irtAtv /T /U i5s< yCr^"C i7 7^w Vb%*& $• -hA/ V
jfcl, jyvyY^s Ai^fX 0^*-^ fl $"W ^
i^icsTXU \ . l^t^-%^, fX^sC. (jl^f)
i fp /w H^ ^ i t ^ / It./ ^ L (J
iu^fc "Hv O / j/" ^JAsU\ L O
twfci tvvv^^^ {L**aJ}
hxX^^^<^c) ^tpxP fr- i Jo^u/j/
( 163 )
HERNIA.
Definition .—Derived from the Greek a protrusion.
location. —Groin, Umbilicus, Labia, Foramen ovale, Vagina, Perineum,
Ischiatic notch and Diaphragm. Through the broad ligament, (Casteron and
Saussier) Pilcher reports a case where the protrusion rested in a hollow of the
bone of the pelvis. Mesenteric and Mesocolic hernia, and through the abdomi¬
nal parietifes.
Contents —Vary in different cases.
Size —Depends on the size of the viscus involved.
Sac. —Definition, mode of formation, and division. Cases in which the sac
is wantingc^t^*"^^ s? .
Division — a. With reference to the contents of the hernia_Enterocele,
Epiplocele, entero-epiplocele, Gastrocele, Hepatocele, Cystocele, &c. &c.
b. With reference to the situation it occupies_Inguinal or Bubonocele—
Oscheocele or Scrotal—Merocele or Femoral—Exomphalos or Umbilical—
Ventral—Ventro-inguinal—Phrenic, &c. &c.
c. With reference to the period of its appearance. Congenital and Ac¬
quired.
d. With reference to the condition of the contents. Reducible—Irreducible
without Strangulation—Strangulated without Adhesion—Strangulated with
Adhesion.
Causes. — 1 . Predisposing. 2. Exciting.
Symptoms .—Depend on the variety and location of the hernia; there are
certain general symptoms characteristic of the Reducible , Irreducible , and
Strangulated.
Diagnosis.
Prognosis .
Dissection.
Treatment. —Depends on the variety.
1. For reducible hernia.
"a. The truss.
b^ Injection of the sac.
. c Caustics.
d . Acupuncture.
e. Scarification.
f Introduction of gelatine strips.
g. Ligature of Schmucher.
h . Ligature of sac.
i. Seton or royal stitch.
— j. Plastic operation.
k. Pins.
l. Invagination of integument.
m Do. do.
n. Rest in the horizontal position.
o. Hernotomy.
(Velpeau.)
(Belmas.)
(Jamieson.)
(Bonnet.)
(Gerdy.)
(Velpeau.)
(Ravin.)
(Detmold.)
/
\
( 164 )
&
2. For irreducible berni a.
a. Suspensory truss*
b. Rest.
e. Low diet for a length of time.
d. Hollow truss* #'* 7 y.
d . Tobacco injection,
0 . Purgatives.
t jk;, < Potu
(Keister,)
(Monro and Sharpe.)
4
ft* introopction oi a stomach tube mto the rectum.
i. Distension of lower portion of the intestine.
j. Pressure and cold to the tumour.
(O’Beirne.)
(Arnett.)
(Arnott.)
k. Ice to the tumour.
L Application of ether to the tumour* (Vela*)
m Application of Belladona to tumour and urethra by means of a bougie.
■n. Application of a large cupping glass over the tumour,
u. Operations.
1. The usual operation.
2. Subcutaneous operation* (Guerin.)
3. Division of stricture without opening the sac,
4 Dilatation without cutting the stricture. (Arnott and Le Blanc.)
Question as to koto long the operation may be deferred *
Treatment of the ease after the stricture is divided ♦
Reduction en masse, (Dqke.)
PARTICULAR FORMS OF HERNIA.
I, INGUINAL AND SCROTAL*
Definition,
Varieties -1* Oblique. 2. Direct* 3, Concealed. 4* Congenital.
common variety.— The oblique.
Sex most' liable.
Anatomy of the parts concerned in inguinal hernia.
Mode of formation *
Seat of Stricture,
Symptoms.
Diagnosis .—May be confounded with—1. Hydrocele of both the tunica
vaginalis and cord. 2. Circocele. 3 Retained testis. 4, Diseased testis.
5* Hematocele* 6. Crural hernia. 7, Tumours of the scrotum.
Diagnosis between oblique arid direct hernia*
Prognosis *
Die section of the tumour.
Treatment -Depends on the form. s
" 1 ^ ||
^ $UuJ/JLs /■' faststfC ^ tdinx/dk ,^4p
ttij L^t zt' C'i >‘— 1
h^u C^Tl/ti^ <^_^t>c^ ^ ^dZtdJL |
J .'
3^ %*4LuUh, lJLu. c^ av//^i
tj-z^- t Lcj, &> ■is- *<l ^z^L^d/ t-^ ] i
‘d-lA-l'h. _ ^/ £^m. tx- ^ ( . s*. /At^
'W/^ls Cjaas. ^ d~t> ^ A^c/^ >$
is) $ <d Lt ^it- i v_<? ^ /C.i-(^ iV $**&&•
fyC/z^ '/l kd-LshJ $-Csd
-p!3Z Xus>i\^>— ot-isdo fx-Jy/js/'c/ /; tt-nAJ /'U^
fasLs / :. ’■ ’ < - / /^'v ^ — d ^X-^y-iL-' l'+s/ j
/yph-^yx- 4*d~4*dt4rvO - pJrdjs. dt#sts~&> s*~~ ^-ddcfr '
■yuh^iX- 77&X <2x/>l, is-c-<il, 4<y<-> /4dZ4<f /*.*-,
/A_- yrw„
LW
^^4s^c) Jd^d- .C^HsjX ^ i
£jA.j-±itZ£^j k ^af".
. iHi®, <ft 6 j /TYHj^L/ ^ Cc / As? f'7~
' - 1 ^ ^ ^ *
C.C> £ >■(-*,£ 1 *■/j ^£<7 _
{pft^CsC _ s * c c ei ^
iy/ dk!-4'trtdL^y,Y_ ^ t
0>t/l^A dn C'4 .cs^-'i djk
Pyi £ O /-. w- ,- ift-T-d) ^/, L ' /TZ, /jp^-,/',*
dhj- /&tf> lAsfo d&y cz 4 Z 4^-y ->3dr W/
(fa>l**-fid&3 *d:.£i.a U< . /(All ■■cddxy^J’
“ 0 Vt- A* y fl+'~ '(s J'i ; ' .- V; ‘ ■ ^ ”'*-Z
k^ .*y's ”"C. - : ;'-— "4 / &UsC£c4 /w Pfi.^4 _,
^ ddrP^-6 /2 -#J-Ai ' /t ^~u.J h\_A- i-4.(, /h i I X.
Q/i~ J? i /d'd^' t ^ it ix L^SU^J
' ^/ji£-ia-ti■■ ifcdfou €«') } ^-j-itOo 4-’ --{ , ’’S'.. i^ jj
39
iZj l Vl .
*3 3^
is A*a*£^
tb~ \i id L ^u^MSrt^. /fuXv ^ [ ^ i lj W-
WmbfaLitZiX l.^yu-t4<v^ $£h*^£~th r* /Twn, £/t u
■]i^|vU.v 'V {T"Ia* -J- /^Vt- ' v t/J
p^K-ftv-^7 %s[x*x . vr^ < iJ-in 'U'
ll / ftvL 1 'l_y /- ^ — Ib&JU Xi? "ftL^CP - ' t*vl uv
/ •, .|4>*j Q&sUzX' Xjf Xti^ie, &J - ■■* ^
§5
14 '^'
-. - /) 1 • r
L^l-
U J g Si p-y^l' }\**«.
ja^r XSiA. t~, / ,
V<
-/
4 / ■■ " y - v - ' ■ - - ^ ;■ 3 / - £ ^ A uj
djtfyJr Cayb ■' : ^dirtdtrGuJ^' —
^^^cu; _. l
^ r ;VnCj /JHX< ^ ^t-
k ^ i ^ ^ i ^Oitt X{_ ^cv l
si V v/V {L ^ /w r 1 Kt-4,. # iAA/fkx f ) >) *.t^o ^ ; v
i |f^ c - ^ J ^ L xCtV&xiiA^- Ll^v * > f^~
^'■ * ! ‘S^Ll xl - PusXU&C ${r £-t t i- c
&
h
'
^ ^ w,^V<>^ Xc-X^Zi<J iSX'^'C' CX^^LiAS^^yj — - d?
i >w <)l' ■ i-i /c^- i^U. } CZ t ,xd t&yuxx /z> J -fis i *
J — shjO't^ ~ >£o^
I ^^‘-a/ f\£ ^ ,C>'U h d tf-jL^Cr- I
J^ J h*jLt^ L. Xf'~Li~#U ept ^-&i J%t C ghsV-^xSL'L ,
_/<yO - /■ d? .;■:)
K / / 7 ^ ‘ V-
JI c, ^ic /l[ i x 'it At dit^yu^ Trfyfhtir^ri, 1 ‘' C L out- l- VX^ |
h4$i»^ 1^1 /uw- JtfStrts 4juJp xfj h. ^t^C 'pA
I ' li)>YlS\ - : y -: ^ •: , .•' , 1 f^.-y ’ n- ‘‘- ^ J : , -•• •*- ‘ ; ■: k f-
0O^\
.a^-^cA 'tj. v^clc^
■j' i '" , ^ t "''•" r i>' /1 hz\stS tVo\-'S<x£Lj <f[,^v- J-' % vfcv> //{,
4r,L ' ' ifutj :J\f^- ^s£<w»iy ,Li
I W i I ; r l f ( \
■ Jrw- ’Ctu . t t 'pUgchitL Lrul\- (i^l>4* Cv\vLv^v^-
v.'-£) A*
f' Ar--*-V*
£5 ej>6 a*A-^ *
JnJ^.c+-4f*-n'i -«-' t^Jr f ]U ' y "s
J t y <rC'Ctyi~*> A®o--ve- ft *» /L ‘ .^
VX
7'A
jfoi^^.’ ’/,"•*< C 7-;7 l / ■’l- 7“
| C?Cif &.jiu*UL &-J. st^'faX - *b?£*~ Alnd /KiT
/
f t- t l C"
&CL'C dsnsl*t‘-$'t- 7 vi^ * t-€L& Cc~rr\ £j <10C
/it o**c
yf:
-4st t-L-C
t. *(lJ
*A£j£ i rJ £ /i
/>W\,J^-
^0 Jc£tid * $y^x/££i. r> X 1 .z-t'&ri * -6 l *> i> tCHdf'V
S-^t*-u*sLi 0 - Cu m-/ >-wp ^ o.7 /x* (77 —-
y>ns*U 0 rt t / > nyte^b —
t£^ ,/>. ^ ItfaSrAr y(ti-^ l*^pS0l df (u 7-[f> ^ - ] C? ’; d ^
•n£* , f - ^ / I
^ i (hjcdL^fj , £0i0??-0^tA*£jL 0u£( ££ .— /f} k^ur &0&\*
■- n,+z i t '-
y^-^'t- c^>-/i, i /(L u J A *t.t£
|^f*i£^u 7 X 0 <J £-£ - /f t2+*L4
(jffip i£fru*z4-s( 0ch^0 £>y^-0 u J f~ *
y^£b^^- /&Z
(? y
4 €^ i
pCt^ScL
(K/ *- ££-£( £
W, *- £&--
/■ ft L-
t
-L /u^<lo> 4M^+~*£ f^j ^*-
lyaZZZ^tj 4# Qt~ /x?k t£,4 < (X tt+<-t- '</ :' > 'J
* - .,) •
^ / *£-<** m. /* y Q £ ^ -ie^— (A? y)
£} l£ 7 Lc&i~(L- ec — tUltcv^Q Py p 1 *4
yi^M*r*U p £*> e.hUf- \ ^ * /)i ~
/u^Hu:t ti^'C t^cfc^D &*■'^ ,L-^h
fZ-i£o L^l/l'tJ-^L'. I ‘ > — /)- £, tsj r ZsC^~0~ •- C J :, Ij’lft*
C? l '-$
• “2-1^. i£t- i- i-
:ft‘
^J1/pV ^ <?- L ^ ; ( , ^ • V . '
- / # A t-i J £i - ^ ^ ^-0/ ~~ /<2&-jA
(7( p u^ld> £M 0t ^C-4. i > Ct(/ t l y f ^ ~ JL 0f\
Ayp - &y v txt w Cx {gf>^ 11 s
if:
i
9A t*V. « V 1 •'t'VWv (At Uj C- v\
_ . t tjCW'w t^r S hfUvw. t*v4 X#-tvw ha^ i '-li ty.
I U^Qh. (jtu*u?t£ (j,tf, lvrt .,j fl'rvv^ £,• l <l. |
• 1 v •'•CiP £-/ f~lc- j/S^
I 6L i / ' s a . 4 - i— v * - j - -?— /
■ A! 1 t~f, £r tftivrcO
f A*'' w -f- {Sr'rC'tviCk'&ij o )i u, (?£<.. i S-t.
ptCtA e, / c-■&■*■<-
" ' ' jSL
*\J
u Y .
t l i * ^ h v / #S>v£
f/v
HI
| Jk &--J 'J'H /"V^v jf'Jj t ^
^ 1
I
i v * I * y < 0 t
/J Sj v»i ^ ^ { * f flf'&Sc ;\ _ //r'i-.. . y ' / / L
*r Kt fit> 1 — ^ v ' * -- *'^2 y,.; , m ./l^
I L '*■ £ -<- ^ CtTZ-CgX £ 42 rt c — f *> fyi^*
SttI-lIs -4y ^ ' / *w c /■V'*’ V' y/^4 L —-
- /tr^t^f/w s 1 £> <j ,-4^;/ , / ( .* w 4 ' - ,
-—
ftw
p
’i H i si
y2^ v- /C vr>i
<1
■Hi f /
I ~~/Cl-lt/jttS/j /.y,/V/ / '-• /'y ■'. V’ /JS<^
> @V t'-yi- t~d . ' ' it £• t- .< tT .. ./-■ t? /v _*- . 7 . ^ ' ,/ -' -■' t < -
■ S' J * _
d
I/ -w ^}i it- /y it u^i ti (j
is-1- / / .' <r- ^
^ /lUu (,;
^t-v4-«^L ^ /C-^v , ~ S£ fr~J-A'j6r& i'-,/#*--
| eYu& JfytJ? l*L~ cAlv ^ c. I *
P - &J f U i £ ^ S US $ }? {' } ( /?) h
^ /?
j . — Jhft'dfce*
%4L A* w?> £ y ~y^ - J4 / / i ■ v p-^4 /4j
kjf* ^ -V-fl - ' , /.iuU,L /yy 4/^4
j f ^ iHr^i-cSS - /^Uc /- U tt&L h yjuj^
w,fM I**sa t, / . y x .'*■ i ( ‘ /
■•7 i ‘ <y ^' 11 6- /»/.‘t-f<.' : r~. ft,
I AO fiU- tsS L c . s di i -
lL
Vi
r.-^r^
U i c Sl. - • / .
fas'Zr tilH'-t'*'-- ■r' is /?i_/. 3^-/C A ‘•ft ^
,&}vcz '-i '--' ■■ ./%&%**> +a~n>4~*-*
Of^^C'. ' <; i'C<"-- /<
# 4 * - 6 ^ *'u £ £** b-Cc +'i-
/ r :” r /
tty, p-t S<
%aJXla^S-L C-'L <-'f-j — C^C,/*-<< ■(_ it-tx..
L /•• /f, -^Asj£***<- ,<^te7 “-■x 1 '
/tf^ W, ' / f/Xv'' '• <-<in" '- A«-' <* <■•' . ''*?■' • * - t A
f
- ' ij
</w4 < 1 1 ^<> t/S -. </& /v» # CS^is^i ££■ >c --■> *-/ .' ( /-/'^V-
v2 ^ y ,)■'■< y £. f'O V ,: v '
1 > & £ fit. ./'**v ^~
.'lA j / /~* > V £ -/< o»
/ A-O ^ /. 2} ^
'Jitft fc*--'’ / f ••'•' < ¥**-*• y >v <*•/'*-• ^,
.^X^A^C^Z / ■
X /7 L^-i'L fj Joi--CrV j/U-t Vc. ^C' i -*
pH & favQ/ ■
_ % 4-io / -<?*v<y£. _ _
<{*£}£ c »*• /••(, vV.,'. j ; ■^i/.y.AAv- . 'A ?f ; , /<J
\,
m
-<-4
J. /c£w (f#u^i2-L $C?p 3
rtiSu> d^ cca^ A
f fat C ^ ^/3< #<? /^Ct^ctte j f 3^ tAiSte* 3 AaAAkJ
(/{{4^t ctedy £*t A o/kt&hyA^
^U+u3tJhs &7 frc3<3 ^ fog e. fftj &rA&z4s 3 a
&Pt3 syt, f r kAtc&b 0 3 iu c-&t&£cc^~£- &j££*$h y{ ^7 Az^A $$£^$2 y k/3
^ 4 * 3#^ &3$o t ^ A3?>zz>
MlAu, 4*-^ /t4t-t^> 3^Z4+ 4*^C d? r &3 +
/h%**4 &£& , ,-i^x^ ^ ^ 3yt^r/i3 ti $ <zc*3^A
r£vt~*i/c *6 jhside>^(f^f
^li&t: 43> ^j/ 7s'~Ct^ /A** A^ ?*-S7
£<r& -AspA A 33 <-S £-
yAt^A/3 / cAA-4z_ e*D, A
, y$ /2 €^/Ae^
^3* *3$&zsn^ 3-
^tU*y4, /'/ k- j>l^. /£*_-> ^ <<
^ /yv 1 tffiSZ%£* & . <• C,
A£» dec . ^
'C4J'4}p9f4 At, eCC4# /< ■ 1
m
<Y>
^ , 0 c l -
‘^\) Vu\
La.,/ Av , firf ( ' ^
jf i ''^ lv W 4.^0' ^\Av'1
J i-QU^
( 165 )
II. FEMORAL OR CRURA t,. HERNIA.
Anatomy of the parts concerned in femoral hernia.
Mode of formation.
Seat of Stricture.
Symptoms,
Diagnosis ,—May be confounded with—X. Inguinal hernia. 2. Bubo. -> r .
Varicose fehaoral vein. 4. Psoas Abscess, 5, Fatty tumour, 6. Aneurism.
Prognosis.
Dissection of the tumour.
Treatmetit.
CONCEALED FEMORAL HERNIA,
Definition*
Mode of formation.
Causes.
Symptoms .
Diagnosis.
Prognosis,
Dissection.
Treatment,
III. UMBILICAL HERNIA,
Definition.
Synonymes.
Varieties — 1 , Congenital. 2, That of young persons. 3. That of adults.
E&oct point of profusion ,—Depends somewhat on the age of the indi¬
vidual.
Contents of the hernia.
Form ,
Size.
Symptoms,
Diagnosis,
Prognosis . i
Dissection of the tumour.
Treatment _ -Modified to suit the age of the individual.
Definition.
Varieties,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Dissection.
Treatment.
( 166 )
V. PUDENDAL HERNIA.
41 , y- ^ %
Definition*
Ca uses ■
Symptoms,
Diagnosis*
Prognosis.
Dissection.
Treatment,
i • k f titV v ( v\\V
VI. VAGINAL HERNIA.
Definition*
Causes.
Symptoms.
Diagnosis,
Prognosis*
Dissection*
Treatment.
VIL PERINEAL HERNIA.
Definition.
Causes.
Symptoms*
Diagnosis*
Prognosis.
Dissection.
Treatment *
VIII. TIIYRGIDEAL HERNIA,
^ Defi?iitio?i*
Causes. .
Symptoms.
Diagnosis*
Prognosis.
Dissection.
Treatment.
IX VESICAL HERNIA.
A
Definition,
Causes*
Symptoms,
Diagnosis*
Prognosis.
Dissection.
Treatment.
\
4,
£pu~^X (ysp^u*^ ^
/^v fiz<^ ~ gid~
\syX\s t _ /^r {2y/>^'^Lfi^ t ^
r ^ &* '^^a^CU^C ^-zrQ-y
^tv^ ^ 4 ^ ifi^ s 4 l*
fij-J^/fl ^ ^ 2 /§4st~* &C*.^ * J&
^ y^ yh i ^ yX-t^
/yyi^t 4) ^ m _ |
&Xt'\X\/XXyj 4&t w
fit^l* -fi (- - &X^isls* *L~ /S
Jl4s^c> ^ £sLs-fi£fi J^Ls+~z^ *. y- 'y- t. ^ ^
^yj^L /y tfifi'j^cy) ya-Xufit^
sl>-v-^'(~~ £^y- &&u£ f i i &-$~u fifi" $CZ J
^ tX? j^i^L m - fyj k^^y
' y>c^ fiLi \-X) fi^A-^iy ~*» £// i&fiffi x?~zr‘i ■-* x^>
ax / ils^r-i^ — cypQ, Xm^xP y a£l^A.£Z ~- i/\yCc^
£s\->~ (f~i*Sfitfikt /yCsCs Aa. £*
fifi^<^jo — ^ £{**£-*" fi fii* (I'ts^fif^
*
$hA\~xp
°t
3?i;y^-U : *.- *&-.• 1}\M & vj/'-• *-;&,;
fcg«
( 168 )
XIII. INJURIES AND DISEASES OF THE ANUS AND
RECTUM.
IMPERFORATE ANUS.
Definition —Congenital occlusion of the natural orifice of the rectum.
Varieties.^a. Simple contraction*
Closure by a thin membrane.
ff* Termination of the rectum in a eui-de*sae, no vestige of the
arms being present.
d* Termination of the rectum in other organs*
e. Formation of a septum above, while the anus itself is open.
Causes.
Sympiam**— Depend on the nature of the defect.
Diagnosis.— Has been confounded with colic, &c.
Prognosis. —Depends on the form.
Treatment ♦
Treatment token the usual operations etmnot he performed ,—Various opera¬
tions for artificial anus.
WOUNDS AND LACERATIONS OF THE ANUS.
Varieties .
Causes.
Symptoms.
Diagnosis. *
Prognosis.
Treatment.
INFLAMMATION OF THE ANUS*
Varieties.
Causes.
Symptoms.
Diagnosis .
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment .
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ABSCESS OF THE ANUS,
PRURITUS*
Definition,
Causes*
Symptoms.
Diagnosis.
Prognosis,
Treatment.
NEURALGIA OF THE ANUS.
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
SPASM OF THE ANUS,
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment .
ATONY OF THE ANUS,
A
BLENORRHAGIA OF THE ANUS*
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment .
HEMORRHAGE FROM THE ANUS,
Definition.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
ORGANIC STRICTURE OF THE ANUS,
( 170 )
TUMOURS OF THE ANUS*
Varieties —-Verm®, condylomata, kc.
Causes.
Symptoms *
diagnosis*
Prognosis.
Treatment.
Causes.
Symptoms*
Diag)tosi$.
Prognosis,
Treatment.
ecnmnous of the anus*
Varieties.,
Cause f.
Diagnosis.
Prognosis.
Treuttntnt.
ULCERS OF THE ANUS*
Common ulcer, b * Aphthous ulcer, c, Venereal ulcer.
FISSURE OF THE ANUS*
Definition.
Causes .. Constipatlon, piles, hard fceces, mechanical injuries, srasm of the
sphincter, &c, &c.
StfmptoTiis.
Diagnosis,-^ Often confounded with neuralgia, sacs, &c.
Prognosis.
Persons most liable -Women from their sedentary habits
Progress. —Generally slow; may be rapid.
Extent.
Treatment, —Various methods employed ;
a. Washes and ointments of various kinds.
b. Dilatation,
c. Incision of sphincter.
d. Excision of fissure. (Moth#, Guerin, Velpeau, &c.)
POUCH OP THE ANUS,
Definition.
Causes.
Symptoms.
Diagnosis*
Prognosis,
Treatment,
( 171 )
PROLAPSUS A KU
Definition*
Varieties -1. External. 2* Internal, 3. Prolapsus of the mucous mem¬
brane alone, 4* Prolapsus of all the coats of the intestine, (doubted by some.)
5, Reducible, 6, Irreducible.
Carnes —4. Predisposing, 2, Exciting,
1. — a. Childhood and old age, b* Constitutional relaxation, c. Want of
tone in the muscular apparatus of the anus. d. Debility of the whole intestine.
e> Peculiar arrangement of longitudinal fibres of the rectum.
2, — a, Constipation, h. Lodgment of foreign bodies in the rectum, o. Piles,
d . A sc a rides, e, Drastic purgatives. /* Prolapsus uteri, g. Stricture,
k. Stone in the blade* i , Violent coughs ? &c.
Extent.* —Varies in different cases*
Symptoms. —Depend on the form of displacement.
Diagnosis .-—Piles, &c.
Prognosis. ,
Treatment -Indications, 1. Return the protruded part* 2. Maintain it
reduced. 3. Remove the cause of prolapsus,
Mode of returning the prolapsus.
Pleasures employed under the second ittdisation-. — a . Laxative diet. b.
Voiding fames in the erect posture, e , Astringent washes and ointments.
d . Pressure, e. Pessaries, f. Cold douche, g. Ligature of small folds of
the mucous membrane, (Heavyside and Howship.) k, Excision of radiated
folds, (Hey and Dupuytren.) i, Excision of a circular portion of mucous
membrane, (Sabatier and Ricord.) j. Excision of a portion of the external
sphincter, (Robert) k. Radiated incisions and the nitrate of silver, (Coates )
/. Cautery, (Chesselden.)
Measures employed under the third indication*
Treatment of irreducible prolapsus.
t
PROLAPSUS OP THE RECTUM*
Definition.
Varieties.
Causes,
Symptoms.
Diagnosis,
Prognosis,
Treatment *
FISTULA IS AKO*
Definition. —A suppurating cavity of greater or less extent, situated in the
neighbourhood of the anus and rectum, discharging by one or more orifices,
either externally or into the gut, the walls of which it is very difficult to cause
to adhere.
Causes _-Any cause, constitutional or local, calculated to produce inflam¬
mation in the cellular tissue surrounding the anus or rectum, may give rise to
Fistula,
( 172 )
Varieties -1* Incomplete or external blind Fistula* 2* Incomplete or
internal blind, or occult Fistula. 3. Complete Fistula.
Course or direction. — Varies*
Number, — Varies*
Depth or extent. — -Varies,
Seat of the internal orifice in Fistula,
Symptoms. —Vary, with the variety.
Mode of examining the anus, for the detection of internal Fistula,
Diagnosis —Maybe confounded with the urinary fistula, when external
ecu t in tula may be confounded with sacs of the rectum, internal piles, ulcers,
Menorrhagia ., &c.
Prognosis .—Varies in different cases.
Causes which prevent closure of the Sinus, and which must be overcome .—
+ The actio11 of the sphincter and levator ani muscles. 2. The surfaces bt-
tfarfisfula^ 113 3 Lodgment of pus, 4. The passage of fecal matter through
Treatment —Various plans of treatment have been employed, and frequently
constitutional as well as local remedies are required.
1 st, or Constitutional.—Modified to suit the case,
2d, or Local—
<z- Baths, mineral waters, &c.
b. Caustics and cautery.
o. Compression—excentric and external.
d. Ligature,
e. Incision.
/- Excision.
After treatment when operations are performed,
Method to be preferred —-Depends on circumstances,
PILES*
Definitio 7i.
Varieties.— 1. Blind. 2. Open. 3. External. 4* Internal.
Cateses.
Sex most liable.
Class of Society most liable.
Symptoms.
Diagnosis ,
Prognosis.
Dissection.
Treatment.—1, Palliative. 2. Radical.
Varieties.
Causes.
WOUNDS OF THE RECTUM,
Diagnosis,
Prognosis.
Treatment.
m
/y / /( . AsjUl-uAt ^^ - fl tyj£^
f^*^y -£'<-'->VrJ <**■£- Stt/a4+*i£ZZl,fy%J^ — ' ]
MjyO ^'fo- 'U&h 4&- ni ,tA‘ '"£«-**-&' <£^4-cA.<2-^ c,<ts C^frCt
rm ^z &- j-< *-A c^t^-g ~t* izt jti&iuS-'
-
e^ 6€&wC r-£'>L-AZ<-{fi-^G' ^~~£gu-^~cA
^ - < 3 * ^ ~ 4 HSUi*
J b^~y - ^ - JV.M-/S'/
^ fozr
4*0 jfa e.,\ CtJ ^ A\usts-e*<~ J^vAzA
eJZ^O 'JdUsZ^eC /v*e£u. — ^
/ 7'd^4y fac> <U,CZl.v C^ g Ic. <^£ZZ ,m
fty. /^tr\^ ^ J c &c^.&£iScs j^C*£o * €L^Ct)C*^0 6 *^ 4 *
^/rvAvt^- &<L<XC
rj t<r^* lJ C&sy
c>^c<~i l c. t 4 __ ^CtT /s*+S
Cudr~ bu^$ <^aU tlH^ x^r^ C*J-$u
- gs-tJ^fr- l ' ^f \ ! ? g?(^,
iP^cOZ^ ,v/,
ChmZi^ , U, £, / '6trtA'tt f
OvU^Cu Lfc h-vx-v dV-CQt^aJz^ cg A &L-* a4-
— jld-tyi-t* v ut/^^tZs-'hj ^
J% $-{-i/^s ~(/fiZxi UsnJr Aj) y — fauMr ijJt jL (Jljjih^.
tfi-A ‘ 6^t(w-w Ci/L^~— {/I
UGjx^a^j -" 4^ (
CaJ-*Lu-£ C.
/tiu&Tt*
i/Cvv u ,
U
/P - t/- — »/V;
Ji^,jul. 6*^'- - ^<'4
/ ^ ~ ?7v<4<2 - C & ^
5 $p ^2 c-4^2Z /<,* ^ *? && ^ Ht ^
i«'W-&/*^- cJCZ~j>J *' A~^ V^ fe-
^-^. ( <=fy‘ZW&' * *£.
Sh\t £t* £-1 f /** 1 * f~~
/Lp Z t JssuiC in+s£» } lCh^t^ 1*&L,
Cs $&***&£•*■' >90 1 ^
g ^&ZZT£Z C? fr tX^* *. ^
f $jf /tr<^*-~G ,&^ £&£c " 1s t ?! -<fto O&s^ C P^J ~ "‘
a>^pC^/ d, C^c^^tr^ j£i‘ t{ ^t/1
j£vlAJ^^ Ae^(j) v1~ t*r~
dtf'fe jd^^S^Pk £>~
: d<- ^ £ *j- $?< //C ^ ;! ^
tfr-tspk ■ /L'~t t *- K r. p. <r f 4-^ __ ^2^- ^ rt ‘ / ' /fe-~ —
Jb 4 ^ y A /t> £ r >^*£ &+~ ^C " ^ [ d c
jfflA- ^ ^ 4& ix^ l < / AsW~ / L^
pd4^ l+'7'* Cs — fe@Ls*Ji P4x~ /h f' i^l ^
S
RECTITIS,
Definition.
Varieties.
Causes,
Symptoms.
Diagnosis.
Drogue sis.
Treatment*
Causes*
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ABSCESS OF THE RECTUM*
*
Varieties ,
Causes,
Symptoms.
Diagnosis *
Progno sis.
Treatment.
ULCERS OF THE RECTUM*
FOREIGN BODIES LODGED IN THE RECTUM,
Nature of these bodies*
Mode of introduction.
Symptoms developed by their presence*
Diagnosis.
Prognosis.
Treatment.
Dtfi?dtio n.
STRICTURE OF THE RECTUM*
Varieties -— 1. Spasmodic, 2. Permanent
Causes.
Symptoms.
Diagnosis.
Prognosis*
Treatment.
¥ ^
SC1RROUS OF THE RECTUM*
Causes ,
Symptoms.
Diagnosis.
Prognosis.
Treatment.
establishment of an artificial anus in certain cases of complete
OBSTRUCTION OF THE RECTUM*
( 174 )
XIV. INJURIES AND DISEASES OF THE URINARY
APPARATUS.
Under this head is included all the affections of the Kidney, Ureter, Bladder
Perineum, Prostate, and Urethra.
I. AFFECTIONS OF THE KIDNEY.
Varieties*
Causes*
Symptoms.
Diagnosis *
Prognosis.
Treatment.
WOUJiDS*
Varieties*
Causes.
Symptoms.
Diagnosis.
Prognosis *
Treatment*
NEPHRITIS,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment ,
ABSCESS IN KIDNEY.
Definition*
Causes.
Symptoms.
Diagnosis*
Prognosis.
Treatment.
PYELITIS*
V
*
Definition*
Causes ,
Symptoms.
Diagnosis*
Prognosis,
Treatment*
HdEMATtmiA.
*
/o
V ^ I* ^
/GT
/ 2h<* £*- **■ £*> c it >ix 1*-‘~ ia
’ftr^Ay <>*>
■ # . f ^~\ \-’ J H £a*~C-t--* / /X< j* S* £‘
A- <u£y^ 2t’ ^ /ad^ddZc. IJ 6xJ* x
At
pT-t^i /U A H- 1^/7l * 7*d &H*H>**^ Asr'rfc. Xsf U'* A< pl^ /it ; C
£JU' Ct*>i iX *r & -** s£**y ih±e*'/xUr ^
Ci-uU - S?&*0 H^ Z ^St^ s~* it «s <fr~upd < <'**[ /Vv
CZ^J sUtm^f dsbr
L , r( f /i*ttt \ A
^<'*~Cc< / Z'< * &L&U J^x/^d **-^£ i J mm 5 / < ^ ©j^
/h£i^m 6 p * ~ /
/'U*-*+*J t*t {el^ Adt* £tA&^AA*s <Zl+S2) /?; C ^
d-s /* sYUuiJiAd** <n / 7 ^^-c^ <* 4 'vv--t. ^
£jb%p+^, Im ’/ / t. y^*-4 ^ JE ^ if xj s* /A^-<L
i?-^-t^ &J \Ja~ t'. /e *. /^j Ttl* dJd
/*,*_ & d**~‘ f* c -'*' ^ ** *«* — , ^
{2?^^ H*+*- s&'de* &nx ff[Z £ * ^ J A*- &f m ' f~£^~
$ A jp~f //fc* C'f^^^^c- £- ^ "tf 1
- Ai\d $ud*d* d*d n A* *~c_,
y
/u
/5Ki , ^
Ctdd £X-JL
/^Xl*—'- X 1 ^ y ^ y*'
^ sjAArtt^C* Aft t77%Zjy^ ( S i t*t - d €,^<
!$ AI L / /' / v? v -' ;■ w f^-0 i/X
l^b,u,L-
•£«. fi*t^u-^$7^Si> zms-u^u ^ \
^ : 7 * tt-ZZ-i, ^ ..^ V V t**t s ^.-J *^, v . w ^/^
•"^ A ^■<~*~t~ j^rylt- r-H, cF w^t-4. ^^M^a-c-cJl*) :J7 /^v
Vl A ^* *f 4-a~* i<x- eX^ZZZPZZ 1
fi' y ® V4 ^*' <a ^WrXX-'&SZ* irf £r^
4 ; «£ iiWJ CLgUrU /t +*> ^J/i £ —
jf^A" Mi. <^wl. w. ,-^.. 4
A-^«) CXA.4 £ZL£%-+- W.
l-v^- f ut **<^ u<*^ r ^ ^
. +l+>*^£. 7* i.4^ jAj
» -/' «✓ AUX- ,4^K,^-«^ ~^‘ (.ill 1 ■ '-^ /‘h-A~"l fyv-C
I ^
^ "■» // /"/ jx-^S"
If *W--C £c+^ Zi,^L/L /TTlT ^
\C^c/ j-g L^ - OC- <2*» . _~ <^*ry 1 y ~~
* * /
I ^) h J ~ <^-e<_ c /£
• JJCZ -<i— ClZZ%'-
&l£^£c> ^Ov»v ^ y /^
7
1—-
/
"*- V
I ^-t-7 ^<>7^.,.^ *,,
I f y^ J~ tx^lM
^ <fi~^^,t~ ~>^y* 6-g<^) Z / _ r <^—'
I Ay*^o.^ <L -B^_ /^/ {S > h c .^t) ^
/fw^) <^fj/^£. ,y
— > 7 c^y'i-e, ✓ " •''_
I I* " t--'t.' r ~'l>~ t~»“V'1- X 1
■ :w
(- t ts'f" Ct -c-t.
[ / £’
I ^t-VV<) ^4.
^ L
7 f
1 Y U-Y-K </■ Wi
/*■*- ^ .•"“ i-w-v
^; u,-(i&
" ■'* ^
/tt^. v’A
-*’ ■"' '« < /,w
^ t >v_ i L u^
/ OS 3 &vS<h 7 ' ,• 7 - ,
A^-Sx- &&XZ3 t'^> ^
I / 'err- a her 1 ^" /u^ n ir,j: / r g^0- fl
[ v^/24^ ') ^ J* . f /^ <' £' / /v 1 1 ,, / / sAf v
• £&f*JZ -+ &+\< 4X~& C*%*v* r^l^cgZ+yij jh &'£+
| ^ >V '-*> 4 W« a _ _ &'pA $
\ tfj £cm*Z^ • jinr-^n^p A h r . i^n u ,
y S U'£ H t*y&+sctJf. fU m t P// J, ;
I s ' ; ' '•^H. v > 4U> ^y »■' >/■ ~^ : ^f /!( y{ /--J»t --'ftJ/^
Uf ^
t^w Urt^fe JUA.-t Jiy ^(-vc/li/yl^tZ
'ftPWrvBs & de^CjL /t<£p~ U*-£D lA I
► X/'—"
h l &4}/l ^fr-i^vy ytc J;- v AsTti^cj ' /?-//i.£ //•
. / * ^
^ ** f p^e* {^' ^^Trzrj ^Vk ^ ^ A </* c V>*
\J^*-'^ f^'^ L *+* 4 ren^t) &~<-A) pb ^ i
LrA-Li U’L bit '<) v/t- o‘ L'Cc"l<~ ! Lkst~ ( P llJrk
l £ .'7 i-^t) -Vv v C fci Jfc^> - J^/ At'i&slrpW /(,-t « t) Vv^
£\ Clylt'v y \4t^, - </y^ /it u-c^^j
lyt^O . „ u^Ut^y €‘* f *^C*4*&49 tin*, pi ■/L^'^^ l ,_
k e -*;‘fM, j>*t? tr JlZOf l 4 ^/£c U >
l ‘.v '■•■■ -. ■ ^
cy%% ^ w ^ c j/j t^ i
Awj ^ J , ^ ITC^D it^t z /*
^ ^ /t n ( c ^ *••« fj fi\ f / t {' /( ^
* \ k //\ y- / f I / ^ t V*
VJltnftcl — j ^-c<~ yil^jy-t C'C ap '/,_.'./ ,—^
tyyZ^- i^ ii U'-wti*. tk, c-t fi), Ht ; r . <• ( ,^ ^|
)*hK ^ 6* ^ v > |y^ V^ 6 ^>Vv"MA^ p V U (.tr (7y w
' f^vvjfv- fv, Iv t )\u> ;:a>' t- -j r7-v ^
1 ■ ' c ^ ^ ct, r*Zvv>' ^ ^•-■-*. -ou / 4 ^
Pj Kin ^'t . ' j/- v— ih% ^ / \
Hi
‘ ^ J r -- 7'. ^4 }■' - "(}"/
■
mam
mmamm
■1
4 -/W< ^ - " >* - 7 ^ 3 * i
_ ^J-uf. -.%_ ' 3 ‘***/
fa flc 'The + ^ - ?4- J* 4 *- 4 * G/H-<Vi.n/v
At &i<£~ ‘it C* Ju^<
/ • C^7 Icl^t l*< ^y+
/%SI~£< y f %*'■*£ ^ s&d/virU+d J
/ > r >*>-c*»j ^ P ^*‘V * « / A Vv * > i
AtxJW
t ' • v >. ^
fosi-gt* ■ -/ ’ -• ''*•■■► <: ' '** >> 4 '
fl^Y i r /ns***/ jit-— &■* *■ ***■<■
.4 /-Vl^Vt ^U C.**.s : ; * - . -> trs\i-‘y
— . / , ( •.
v. ^ c /< /i~ ** * ^
i?/ £* i- 'f' £***> kb~ i'Usn\.4 )— Sl&<<3
^Qf ‘ _ ^ S . * y/y y //^ /
& >-c S^+'i~ S'tY- A &t * 4 44 J* ^
^ ‘ — «rr. ^ f x /.iv, 1)
y/U^
|i ,.- * <*
3^ #
‘ “ y
T&jL+jf
$7- /> ■ .» ^«. ■ - /. .#y ^a-h-ww^
^U-*-..*''/ jtCi>t.%r C+- ■ /y 7 fiH>l£r*xri
^ A. 4-^7 a . /* s* .
tlej / h*yf~ £±<4 ~-*~*
}s^ If % U-V\> ,4 *4s4r(F}\, A'/4 ? l *■ K ( «'-■'■ ' **»'&
* tU^ : /> /l £ ^f /'t ^ tr +t-
AfCl-tr K^ £t \0> OLAa^)
Ti
^ ^ A — ™
T_ «h» C A *'* ^ * * ,K ~ ^ <?'* ^ l't/H'*4\>* m ,
c£r-£t± i) <sL * ~P ^iv^A C4 C r z<^£^
t dX. t~4s ^Vr. r^^r $~&(-4!L />,(,.
ift^J
i5{V
/.
if ✓ t *»
■/-' ‘
9
"A
2^ *7 ~ '^-V i- ~S
0 . ' - * "****''
^.*v^-^5wv-w v ^ ? C&* is%- 3
^ ^ ^ u ^fc’ fe' ^ £*■■ *--w /?{-■ ^»U--/■ '»■ **'_ /■
fivy-t/T-r JsC ~Z^^CjiS ^7»w^^£—^
| /'Tp^-C^X -a- \~~pOf-
S*b*-#fe*e*& /^M. d!Vw-?>J W Shifts —^f~
ife fe£&& £t*A-*€r' ^t*N»r *£?
'~Au&s*-€* *Jt t<.-$L~f* /"
^ &*»-* $ feists* A~ f ftjsj£-C~ *£4%^
<p“jfr?4 >*, /f'^/y/.-v, ^KTJ -t-^ P*+—gz)
JUcts*'^ tsL>
I
D&jhdnony
Causes,
Symptoms.
Diagnosis.
Prognosis.
Dissection,
Treatment.
ALBUfipSfURIA.
Dtfinilio n.
Causes.
Symptoms,
Diagnosis r
Prognosis.
Dissection.
Tn atment*
DIURESIS SIMPLEX,
Definition*
Causes .
Sy in ft owls .
Diagnosis.
Prognosis ,
1) is section.
Treatment.
DIURESIS UREQSA,
Definition-,
Causes *
Symptoms.
Diagnosis,
Prognosis.
Dis section.
Treatme?it .
BIURESIS SACCHARINE
Definition.
Cattses.
Symptoms ,
Diagnosis.
Prognosis.
Dissection,
Treatment +
DIURESIS CHVLOSA-
*
i
V
DIURESIS SEROSA.
Definition.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Dissection*
Treatment.
SUPPRESSION OF URINE.
Definitio n.
Causes,
Symptoms,
Diagnosis,
Prognosis.
Dissection,
Treatment.
URINARY CALCULI.
Definition.
harms assumed by Calculus Matter,—a. Amorphous sediments, b , Crys¬
tallized sediments or gravel, c, Solid concretions or Stones,
I* iMmorpkous Sediments and Gravel.
Lithic Sediments—
a. Yellowish sediment.
If. Red or lateritious sediment.
c. Pink sediment.
Crystallized Lithic Deposites,
a. Red gravel.
Oxalic Acid Deposites.
Phosphatic Deposites—
<sf. Triple Phosphate, or Phosphate of Ammonia und Magnesia.
h , Pho spha te of Li m e.
e. Mixed or fusible Phosphates.
** L " t '*'^ y ^Lni, y&re*/ ^ ^
tt-*- d*.f*+£ZZ ^fi/o t*^ oJZZl, CU^> *0-*. <*-/&*, ( ^_ eJ . ZfcZT/u. /' '
zA'tfAlr*
tt /fc*^ ^Jr Ar d!. ^tA^y44*^u f , a
fl* / &£Z*JL. *r + p - + .- ^ e ^
/£* ^ ^ , aL&y^^
f%c tlv ^ 6, 4*£**y ^ Ct^
f ^- &£U-*s y /f ^ &L&t <**£2 ^£ 34 *^
■ 4 ^ ^<1.4^ - ±^Lcfillet, <<C*cdc £&.&4L£ ^ dy, ' £4^ A. €, # 3 ^^
'-. ^s >
\
1 ^y <*/&*/*€ J /Ka, &4***,<^yf , /T^
^i&iie. <t*A) <y^h A /.
**** /' /fcr cv ^ pu^c, fajC^<C& << R^
x *<-/ ir^ <f^!t *■
^ /--Wc jdrz^^ /d&t*y, &^e^c&£Led ,
1
7
^*4. //«<>- /»^«(«44.
/
<£tS&
4k*rj
l^US/dd A< ^ t**xy - fe^W ^ J5tz
I ^7 jit-*** *r /ft Sn£c yd*&?s£ , S%2* <cd^*ljQ
^rvH* &*+y CeUt^Csy £&~U Jkac. fede 4~cA/ Atfttt $U /W ^
&4±* i <5e4^C? ^ dt£c*^ /Ac UWH& McZt^ t)
dy Js&rc+t ££ *ta +*d
6^/^ /" U&hdtf _ j4s^ /d*yt G^ a 3§0^/cu^ Jaj
^U-yf ^ /x^p&c4^ £€*&&- ^c$/*s yh&**s d^edt/d^
^ m ' ^ ^ y ^ d/r*r *jJ-
4.
UM+ €^£s^c^
tt if " ttec ist,
Y
4*^ ^ ^Wi£ -
4*t r , fliUy &ts yep?**
/& y&*eP. > ^ !> /2>/.- /sn* r jf
_^^4-
•■ ' ^
ly *4
- , Jhvy jL
ih*£ &tA Me ^OU. tih&d €&#z,<£ fis-yr^J^ ytiTht*, ^&rndt£4s
jf /euf dhA / A l^ctL^/y ./ ^
i^Uct£t^4 l*i MjL ^htJi' (t $€&&*%, &*z &> ^e,
^ ' j A &fod*d / t/J di^^'UrtA/i' —. $/lruv€t f
&%X<e y ic^ce &L <yll<^&lz& ^fij ic^t &** CiL^ ^
^ &$AA, tiApa iU lAc C&ydtX, i^dr ^rx c^ ^q z
'
V
. •
1
( 177 }
/. Oxalate of lime or mulberry,
g\ Carbonate of lime,
k. Alternating,
i. Mixed,
j- Cystic oxide.
l\ Xantbie oxide.
L Fibrinous.
m. Silicious.
n. Pros tat ac.
Origin and increment of calculi.
Forms of calculi.
Size,
Specif c gravity*
Surface.
Colour.
Odour *
Nucleus*
Consistence.
Chemical compositioti of the individual calculi*
CALCULUS IX THE KIDNEY*
\
XI. AFFECTIONS OF THE DEFTER.
WOUNDS*
INFLAMMATION,
PASSAGE OF CALtRXUS MATTER ALONG THE URETER
Symptoms.
Diagnosis.
Prognosis.
Treatment.
12
Symptoms .
Diagnosis.
Prognosis.
Treatment.
Varieties.
Diagnosis.
Prognosis.
Treatment,
Causes.
Symptoms*
Diagnosis.
Prognosis.
Treatment.
✓C
■ — - - '*Hf^
4*'*^^) *—' £c ^L&iTT*\S~- M-
* 2 . , ^ t>
I fyCiA <Av cti^J^U^ ( A t rtx^ j^Xisit^-'i^. ^V-
ffy]^ti^L&^*\*- C<4>^ «r ^-■i''/,it/^-^^
i^-t^ l<**Lts i'1-1 & { > ? /*-X* _ ^^A-x^c-w
h* ^\\\^£aJ ^ Jj - t)
(yoJbi/^jL^A ~ ffov*r\-&£ — (JL C^ *&"l--w ^) Kv
&*t*rv - \y( )jh€&sC'tjf ^ fh'-^t-f y /(^i^_
&*~ fyt {Ld^&£ * ?> w
. ^L ^-f' r y\.^ fr\Ji *^~ ^t-t. ^ ^ A^T-t^)
4r^t A / ^
j~y+^ ^JT v .^ ^ {fJ'\A J L* ^V“>z3 €i^JtJt? kJ~ U^ y -*^-^-
C&^- l-' ^-o t /T}~\gl*^ $-*<* j £%
Cyt^Mt^A- cL'-J/di-^y r /^ /-^ j*£*t~c**' ^p /^-u
|^*-re«X e«W ^4r'^tfr*U4< - A A{^ ^
^ ^ /y ^ p - &/^ —. /i v^r.
l^f j ^ A*r^—^ A-** Aw
u ^—■ . l ^J / ^ iy ^
l^c^jjtr^ £j _ f^bi/^f ^C f t^j
J+'i-tj'Jr-U ^
^ lsr^p4*4*&%Z ^//w^-Q w. ^.jut b * ^ ^
La^ f y Lsjf J.-d ^ ^ '' '/A <= ^
sj ('Kv'f *>2 m -~ 9 &Ct*^ {K^,£/k ^
^J| ^v'-'^nT /trv v. i/l^4 — ^t'if*x~ ^\ j
fpTh^j .. ^ ytf^O-A 'rr-^1) &_^^'{) p ffAp^A Av 4 -
’*-<■ ^/v- w y ~*i ! ^-\ ■^ ,- / i^.'u-^^'-
✓7 (54^4 <?C t (^ ( k . ^ pn^i/s- /U ~f)
inr P^vvy^ ^ (/6--<)}L^ CfA^v^V' $y\^YM^ iry^ Uj
j [/faw&\^
^4
£-4A+m> /
C 179 )
INFLAMMATION OF THE MUSCULAR COAT.
Causes.
Symptoms.
Diagnosis.
Prognosis.
J Dissection*
Treatment*
Cause# *
Symptoms,
I) iagn o sis *
Prognosis,
Pis section.
Treatment*
INFLAMMATION OF THE PERITONEAL COAT.
IRRITABLE BLADDER*
Definition.
Causes —Teething, &c.
Symptoms.
Diagnosis*
Prognosis.
Dissection,
Treatment.
SPASM OF THE BLADDER*
Definition*
Causes.
Symptoms,
Diagnosis,
Prognosis*
Dissection*
Treatment*
PARALYSIS OF THE BLADDER.
Causes,
Symptoms*
Diagnosis,
Prognosis.
Dissection *
Treatment.
RETENTION OF URINE*
Dejinitioii.
Ca*ur}*.—t?*Tidyii[9 of bladder* Inflammation of bladder* Spasm of the
neck of the bladder, from cold, excess in wine, canthandes, &c. Irritation
produced by dentition, hysteria,, Ike* - 'Enlarged prostate, displacements of the
■womb, pregnancy, stricture of the urethra, calculus, laceration of urethra,
abscess and tumours of the bladder.
Age most liable*
Sex most liable. x
I ( ISO )
Symptoms .—-Depend very much on the cause.
Diagnosis —Incontitience, tumour of the bladder, &c.
Prognosis. —-Depends on the cause.
Treatment.—a. Warm bath. & Opiate injection. e> Evacuant injection.
d ' Loss of W*»di general and topical. The catheter, /. Forcing the stric¬
ture or dividing it, where it exists as the cause of retention, g. Puncturing
the bladder, which may be done in three places by the rectum above the pnb$.s y
or by the perineum, h. The inhalation of ether,
Remedies useful in certain rare cases.
a. Quinine in intermittent or periodic attacks,
b. Caustic bougie in irritable neck of bladder or spasmodic stricture,
c. Affusion of cold water in relaxed patients.
d Strychnia in paralysis of bladder.
e. Alkalies, when the urine is too acid,
/. Large doses of opium, and perfect quiet when the usual modes of relief
fail.
. *■ incontinence of urine.
Definition.
Age most liable .—Early life and advanced ager
Causes .—Diseased urine; habit; irritable bladder, hereditary predisposi¬
tion, paralysis of the sphincter vesicas, from any cause, &c.
Symptoms.
Diagnosis .—Retention of urine, contracted bladder, &c.
Prognosis,
Treatment .—Depends on the cause.
HYPERTROPHY OF THE BLADDER.
CONTRACTION OF THE BLADDER.
SACCULATED BLADDER*
Definition,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms.
Diagnosis.
Prognosis *
Treatment ♦
Definition *
Causes,
Symptoms,
Diagnosis.
Prognosis.
Treatme?it .
£&*ir'U-A
A 0 - p^^%- 2 cAA<y ,
A^ ca*-J 4 A^t^Z 6^
*y L+ZAZZA ^ tyj^ < p^~/ i^ZL'
AZs- , /^r *m /^xrz^c\
J?tl? hA +^*A) J^r-^jt^ <txr~*yL ly£ ~ y^AZj
J- f Jxs^rrYX A^vot<.-^ rt .y / 44^6 ll~V\Ap
'JA* f-iAsSm {- ^tZ~$V‘ if-V Ac-^ &tZ&cd£ut
jfr^A- 4 s£ d&srvu^b** &s*~A feud' ■ A?*^l/C*
*^yj dL^Z^Z%Zj t ZZ -4 y^ L**d
&At) yy^ &az ^r fs\ij^f — * $ u$
i^AuZ ^ aAuc**~ /U*AAiA-^ y ^
Jy/ & 4 irf-&Y u*--^ ^ZAZZ, ia> ~$&£$ $y ^ Ma
A y! 5 w£ * r '- C-£tS$l - ™
A^b j^Lst'-xA *' I {__ w
A^// ^ ; /l^A^ /lAL^t* V j ^ ^ ^ < -f)
* AAaA<a^ A- ^W vL^AjLA ^ ^
JAA- &> ^ - yb\^p uA-X. K-N jkz &r /t^Ul u./ Zc&Ai
Zp$A' &* /tAs**~*-Q _ gA+Z) O^c^ (M * -u.^
d^ofZZ y &«Z) A {A-lsZ **-<A-£* C /-iX-
/ ))Z'Ax > ^-**A a isv* 0 -y y^xJZ^^ ***^ f^ , ^*' v ^^
j$^*ALA- t ^ / f l Aa t «sa-v <0 , f / ; < .^
^ !?£-*-■ h-t* 4 ) (ss~i-i ■'(/
l *-^w (jA ‘ ~ 0 ~\*/’ j(p)-{X j*-***^ ^
y^aAA caA^^ 3 t^y^i AA^OiAj^
^jf Lrd fd tAv rrvt (yfe irj §£etdds^
^y cM^ - A-3 ^ (U^A cL, TuZj
- A40+4, iXr~t 4 tA^jp i-£-t\.gt cLu, jr^*-
VjM^uC’utCvv ^ tO VAX'—
-^'U-*. cij&oi ' jp^r- t~Zy b-<^-d-*Cu- L j h^r%£A~rz~
t^c^- - £*•> fu*U~~- ' h fav p-v-i*. 0Z^
b%*JLc^ p, Z 5 ^/". ^-v -fK^JfL ,fco ^tJUv
^n^i^SL - Uzz^-pT^ (h^c,
fajd ty- /kC^^&v,, .,_ A
fc^a \ j s-AX^t. /■>■- Lo-L^& Cuw a > 'U+JqjCs
j^/4 i-w .^V. !AV^vvvv\ tiXAw'l'' £Z^v'^~tn / c-
^VvxAvl' /{a*, y^> - a.., /j^'Wwvvv ■ '-!'
^irnr^Wwpi/j fW - ^!V#%h.
b ^CiAS-t.'it^ iA'Vti^^(X/t<| f i (M^vYis s, lrU, t
S^mJa^- A^yt-c $- 1 , gSCtA.,,, , > f fi'l a-itifi\4 ;nC
Ih^^i {pi- l I,- . //Iv'-vw-^ J tA-Vvv J— -
f K t^ 'fe (h, Un- ^IvVYfWf C 4 ^XfJ)
faU-#sl' /^fnrrfs d^/YrjA^. iry^v C^y-($.*,-)
A/' H/H'V-^ ^ U^^mJL jlA hlt^pji^-^-t (tsi^
£L*tdt- i^ps} 1 ~\
l jj * ~~
t> l/v
‘-jytL. ts^tr-yLc^)
X-
c^') i. f ’ ^ Ai/ • s _~
4s^^<2-'0-Asc~ Pt LcZ^t-.-- _.
/ q >lCt $ f" 1$? ^ */ A,o XX-
M UtJu,6i^u- <rv X? fHs'A
{/J ^ S-C/ptyA/ SjA
C^CJ _
&/t£
^ U -J> ofj dad- (9~
■— f
00
Causes*
Symptoms*
Diagnosis*
Prognosis.
Treatment*
ULCERS OF THE BLADDER,
Varieties*
Causes,
Symptoms*
Diagnosis ,
Prognosis,
Treatm ent *
TUMOURS OF THE BLADDER,
Causes*
Symptoms*
Diagnosis*
Prognosis*
Treatment*
SCHIRROUS AND FUNGUS OF THE BLADDER,
HERNIA VESICA AND PROTRUSION OF THE BLADDER
See [ f Hernia.”
Definition*
Varieties.
Causes.
Symptoms*
Diagnosis.
Prognosis ,
Treatment,
RECTO-VESICAL FISTULA,
#
Definition*
Varieties*
Causes,
Symptoms*
Diagnosis.
Prognosis.
Treatment*
VE SI CO-VAGINAL FISTULA*
( 182 )
STONE IN THE BLADDER*
Mode of formation in the Madder.
Causes. —1. Predisposing. 2. Local.
J. Or Sex. b. Race. c. Age. ^.Constitution, e. CH-
mate. f Mode of life. g, Water* h. Dyspepsia,
2 - Or Local —*s* Stricture of the urethra* b * Enlarged prostate, e. Sacs
o. the bladder, d, Paralysis of the bladder, e. Chronic inflammation of the
bladder. /. Lodgement of foreign bodies of different kinds in the bladder,
which serve as nuclei.
Varieties.
Size.
Form.
Ifumber.
Mode of growth,
(- audition hi the bladder. —-Encysted, or loose, or encrusted.
Symptoms. —Depend on a variety of circumstances.
Diagnosis— Manner of sounding and use of the stethoscope, &c*
Progtiosh.— Depends on the age and sex of the person, the condition of the
organs concerned, and the size, composition, and condition of the stone in the
bladder,
Dhsection of the bladder when the stone has existed for some time.
Effects upon the ureter and kidneys.
Treatment .—Several indications.
a - Hemove the diseased state of the urine upon which the secretion of the
stone depends.
b. Palliate the sufferings of the patient.
c. Remove the stone*
T. 1 his indication maybe fulfilled by a number of agents, most of which
have already been alluded to under the head of Calculus,”
I ne-second may be accomplished by demulcent drinks, add or alkaline
medicine, according to the composition of the stone, warm baths, leeches,
anodyne injections and perfect rest*
■ J The third is answered hy a variety of methods*
a. Extraction by the urethra,
/j. Solution by injections,
c. Lithotomy, which includes—-i. Cutting upon the gripe. 2, The high
operation. 3. The single lateral. 4* The bilateral* 5. The rectovesical*
d. Lithotrity and Lithontripsy*
.Preparation of the patient for either of these operations.
extraction by the urethra*
Cases to which it is applicable.
Condition of the bladder before the instrument is introduced.
In strurmnts employed .
Position of the patient during the operation and mode of performing it
yt^ou-c£ c* /h^ ^y~ L ^~^
/?J /»■ f/tsis ~^\..i. 6t'TTsp\.'£*- ^£/y^ULs/l < ^--t^
/k. c^tiLt- 42 A^~£Hf /&~i- o/- <<sC**-
f**JZ)/^ '* 4 -- <£y ti"fcZJ?:* 6 r
/f h'l i)~fihr 6C*r~*** '"*& / /fju> ts) <yCpu-&~£* A
(Lc^J cut &?/. '/$- ivA ^ &*+•-&£-
djn*f>* t> TK& $Lt^ ^**~*r»» t)
04T2^^ ^ /^/~£ /^X l
fats cote - 13 ~ $%JU cL^Cj ^ /€^ :
£Z~ ^u<Lu U^> ) UH^ h
$k^4. d C^H-cS * ^ /Ia o
A%^ts ^2 ^ ^ /W /^ v
-p- &L^—gC $4*^^ gr&~£)
&w^7 ^ <SJC^U ^ dL&rf ' ^
/l^/tst(s^ w A & Q o4* —~ v t+ ^ jfj. &^z-4 ju~
cA<? st/tJi' c^ t ^ ^ tJ 4 ~—
f9^HAr&C&- /7 Lf& - ■/^sy. t£/Kt- 4?— l*K.-~2 /- ,
a^9^£^- a^u«> /****-. '* ~
^ (pi***Qs£t ’"— /^2"* v ^ us&£Z*~Z j
tuC~<sL ( r >^ /* '^-'/^vu /4 a ^4 />> t y (f a-^i —
/?Tsrrt cn4y, /' i ^ f a//-< -w- ,
jj?nJ4tsd - ^ —' <^4 vUt~1*'~2Ls i 4?
.&A^l.oo Aw) ?
l^u7-^-~ tyU^o ^ /}4^y /GUMj c ’ u - JA
^ ^ ^" ’y^ ^ f , L '‘ *ti^ j
^'*- <l^4
y "-^ / j lC
ti ^ o^h -t^_
&/ Y
ft /^&0 w /^LjL ^h^r-
■ ■ >-v^V (*^-<)~^jh Ct t- -L - 1 * m
I. ^9 pfr^ag^ _ Z-^ P
P) ' pai-~ - *pt~<i£zr _
/ /£- V
rjf ^ CUcs'C CvU~'
^& rlr ''~ t &h £*•*' ^.-it/pA^gp fb '-«— Ci4i— l ^, 4 "
^ hcr-^' j 4 wCl* 6^ /y
ff O ^-o^-- ''~c(, fi ^t '-on^' cJl Jt:. o- ^
I ^»? • ‘ ■ J y _ _
^•/A ffvUf &U, /toeetc* >^z ,; ? ^*v^)
f.i. &f&s , . .. yi^ > . /D . yr //- / v—^
/ / ^ ^ *, 1 -> * *' L-j
//u- l [ ni pyc c-^, /z^y rf t) - & My d^JZy XZPL
*&*#■* - y^-^:Z ^. /
ty-Mig fnr>iD
rf-ZKc -*I asc) yirt £ 'i^vauty (J<rtv-t^t.^ ^ £
^-*-*.3
/ Yy y-^ Jitx***~ C. J- Lt*- £jrZt) ^Coi* ^-~c»<^CZ?
| lcZ &■*&- ZZ - ■> s "^. j C' * -'
y AtJ (, — /lZczZ*^* , j ' <»
Ay^/tt*'
7
y // y W e^ V. t^t; v^t ,«r n __ ^L' r V^L^J
^ia c t x $ic / ^ ^ JfV
tf/2»y~ JPi- S^ <^ i> <h u-iJ- u.^/%; /t-
lb y ^«y»c*t^ /►/,.. .mZ**
}yu^-j,^j.u^ jt. lX y> t aiuuiJ kujtsL
| y 1^ w’..i , /i^ZzLo rkl'
CM/' J b ; (
Vv
■i^
*“*• /“TV**'"'’ ' . ■ ' ', '
&UC? twfc oZ&f i '
$r4k4i?
ftu
0A&
^€- €^Ct d&^L-
f >^
vkr&sd &u*slc* &tt-<?Ji-i*-o
Atvc-AAt
t-ix I
XuA
$Cc7^ ^pmes^e <T* i
/( f ( t '■ /C / ' ’ * J
£-&&■?' /*.:' thj/ts tv* &£' ’ t-'S-tdUr ^* rt ''-' ~~
sJA jf&nf&C **&■■ p- '&t+*0 At r“ 'Uj£u- At**' A**t't-
A^zx^c Ttu. * &et+~.£. i/.‘Ac* L P/ £.&%.*i^ke i *H
fitZs &f,\ .
UrtA- c fL^-i'-e ^e'
£■ £t-t*U*L4^ •»-
j A '
t/tr~y>
< ri£~
'&fcfrr i *{U 4, -
a*y
cht Ate U \dCr •*■ <* « — « 9 *
^ <£^S? ^
* i
7
*•«• if -<pr
~ ^ , Vt- ' , i'
p
V* £' «4<> ^V Wr >* * ^
l{ J t
¥
1%.
Jr
+:*) V"<&0* k ^ M&
■ i> i % '&?t**G**^t
-*~ -■*■* n»
»/ <2^^ ^>t~A &0 A^r-iS-s) <te A* *•
- /*
t
■ui
&AA~cd —
<4" Z?<j7u-t~n.) —V . ■
AH^r^cd tfeuj tu ■J'u+^yC' pv>**~ Ju-i^ f &-<-* i ^
tfyfru ■& */© ( , '-- ' f ~ <lM.-€4+-\s
f h* Ip- ^ ■— £&~£r At*
l/ktCr tSi^th- m£ t kl: u7) 't&-pt,y jQ( i,-y kt--i
^ $ll$/J /M't' V' ft'te pA Jpk
C* j 4 ^ 7 ^ ^ /C/ /Aw j— *r /tf jf ty
V ^ yd ;^ 0*^c^ 7^) Z$ &zty
A^U*U iji lM/i7 r ■
^ i -^/ d t/,^^H 4 4 ;v i>v <V v 'f ^ ^ f' * *
fc. j vCc£*'& r< fe ^ ■ ; t . c >tt J -^/ y '
/</l/W- '4' •. ' ^ I V. ^fJ\
V^£^u 4‘ - Ly /-64) *"
gy* - -
---- r ( - _ —
k-viyv ^,t-c- y ?->-*—
rt-***^ ^7/^S ^ i ^brtJTn-Cl-i,. £L. — ^
.JZl&u^ 4j, A^r^-^U ^Cx^#wrf <£ ^'$*' v rf'
^ fa* htt'PvAcy tC^t-ZlZU <?-**{ ■'11-/
2fe^,
/uz-Al fapyt~t~**£j, v ^6*Lj7t,£-7e, fa'/nz 4^7/
fefctli! - A+yi £7n a& T^c
£4*^:1 44**&*1 ■—■ <^**y tiSf.s/'ts ^f'L^-(_ l
&*my ^ &„.* d
rJ)^ <1 _
= 4 ^^.^.- 7i.v7~ /fact c'PSf. t-i-A* -T, <
tf'ft/yt.t' f ySzt*..: e A *«,&Ju • ■ •' -.v4- - '/
‘^2'* l £ jL t,C ^r £ZyZ- /c^ 1 Ty'f' J
7i6£tMy£t- is4t^ *_ Uiy/y-t^ ^ «£^c, ^
^ ^ J&U&. tttsU &c.,e J^,
/A-^'THsy rtx/v?.-' /'A i 4r>^ /drr s *7 A ■ t- i2jr> XX , 'ZcT^-fC (i- 7^ v*’
/7 TTiAtiTy <y _ <a_*+* t u. sGuS a ^/{/V7iZ^ /S^K
f*u£~ s?,7) ^?> ie Z7Z^ a^J2>
jh^****7j^ — As. trr^lvu^- . ....
A^^ o. ^ *:../* J “ & *- ^ OdLe. £l-^S)
A )r7{>-/!t*x.^1*7-6-£• e> rtt.
tA AuP s (>1 .//k. £-u t t ., ^
X^t ^. <2rt ,~S) *z^ J £Ay7Z7 —
A tuzT^. t • ^ 4^^ty /AfeX} AAu-
/t't-fHC X* JiA4*iSi& Arffh^tO i~y^\U\^ j’* /*fe A^1]' lv
- [7*& etxxA+.fit^ iJ 71^ ^ «-w l&iMi
u~A<x- *»i^c4~Ll. tUt*) 1+tx.t-
-£z,, 7 ^ ftvxM
7U-t"^07E£ WX-W IkiAMjl / ) y£*L-j<!.\^ l ^J.
^'rx -& sj {u^jz a j-vV „ tJt i > — i-^/. > #
<^*'>'—^ l C<- L t, t
Im>o, flyv^j fio^ x {; . ,;, /,
j^fn^
ilu 6^J>fcrxfl
sr s= ^ ■?
} As/t^c ^f»v^ /# ^
£4 J^cC' At 7^ i^a £Up e 4 *^ • '■, ^
fa &PA£ Z/ Aif&'tf/- AlpsM *> > /V //•
J&Tp^ Ux^A^Jm^U^ ftsvAfc +4<S
v j| ym& aiMU, $ a/c pf?^*Jwp* £%& &ut '-"/'■/+*.*
ieAfrzo ^4^ & 4U&+ %y /&..^tC ^^ A;i^
/ZzfrAs QlpMy be ** 1 %k%€<^d$^ &*-■*><£■ i J&*‘ m f- t- y/'T'fu^
Ql&C 'A Mv£<2nsJ*& iu $£& * Yt 1 : '4tZ»Ct fi f%pp y £t t ^
&AiZU }y^i f l-P K P fyttCL $L(d} ^ hxA^A^c^ _ ^VV (J^fH-X^/^.^/ i^t w
/7 bi^dUii x, £u Judith ttyjC ^ *?^L *s//-t £-/ jhr* sl-
*<*Z) hp '«**£ ^£r ^ A2ty£t^ £*+~ Az**^±*^ h
&j ^ /&i^h±g U &+y%AA4+r £# **^AtT ^
&4&*i #** ^ /<&%&*+,
/fats btC^C'U ^
0- dfrjfiez i- v ePA^ x. ^ ^4l&*4 C^-C^ /'*?* r ^ y ^j£ r /j
^ j*. £ tt A t^tu. Y^*yAc ' ^
p <^v &^t€ **~*£~*b~ ^ £>Z '
^* r ' ££,*a**^ /'^- £. (^IhC^X* i * yf. : ^ ^ ^ X ^ ^ p /'
fb^^L ilAjL 'fFC** (rm+h* w.^ ^ Xtv/
<2^+t— f
4% 7/m: p*Z't*ij?-^&t~- *y v'iv> L 4, ^ C c^.^ * <.--.c
„ **]' JrQrArf *i~ >***<■ /c e? * 4 *-/'/^, ,.._.
JP-'Ptf#**' f if ^ »• l£f&y*— st-l-/'Si-P^l /'..^,
sd&~i — ~' ^ ^ t, t-4. <f( ditit, *i ts A 0,1
‘^&\»j?-*Ztc->V ^h4- M-*+t*-C •*£ 4t«*trz*.^..f y ’ ,
I*- 4 Q^i AiSt> Apr I
-fC ^‘ pi ; JZ7^A^/J w <Jl IsiH t i } ^/j
&Pf*ixc4 jy fyx^ pz 1 i'\i\'tt /y i_ / /^V l. ^ C ^ J t*
£&UM\r jry tpcJ\ V lu^to £*p (j'A pfc
11 y t-L-Z Id / Zk, i o v J
£-< ,__ -
^7 *&A*A £- — /<h~L**4~ U~L A-v
r $ ^m-^V/4 - <=/^'i^p L
/**+** &t#?tr>%^^ — /h*^ j*v^+
A^a *k&^tM& —
/fe ^Kti, *—- *t^C^ f" } /C~~j ^ £ t- S^tU
^ t ✓**?***-- A.
f&rP'i-C ./‘fL-tef /I, _. / _ -t ^ _
&*-j0trL4r-'W> n G..U C &//e-t/-sS* /*<d Tte <2> ^cL^.-fltA
%? l*+u) fiu- lifc^c. rufai J’tJ'eXr — ^)
*4jr *#" tfrttk+t^c /lint « <& #nt,e**9d*W & **i*.p
V,5Lt u * £zsr-<i*y ?«^M- &UrA*
fi fc'v a " ~^r u -* /> m%?*s
/^ awcA^., ^L f /tv ^
■^»<-< Oh./Y. (r t4+-,.l J j sH>
4tia**' / 2t»rtt'/t »yt/ y<wjw
^'K/yi j /</►£{, An-ti^j sQ ^v ^ iJJ
Uncc ‘7 $*>•'“-£ ^ / t*&*-*- 4^6 ^4
£tL'£i-t4* lhl*~v*4 A '( £*Ac fitAy 9 /<*--£ si**n~ £. iJ-y 4 $ „
itMxi&Ud - to CiLt-Uh ; 4 a ^1u
A*- ** w6 " ® L **^' 'Je-ja 1 /•) rfTt . dj£f<?M- £C --
^ %£**** ■^ tT , t ^ ,
'ft t. -<4fe&£*z&£. /t-i- j nA
/i4 fil]4AS,t ,4>>^ t^^ vAs &cJ/iAU /t-^/i^^
C JT - /'T-j-'r'*-^
4t/7icZ — fet/t-m * /-*4M-v<^ Sutp.% rfh-t^-s-i(£l. tu+rr^A.
■j"H ^ ^•' < ^, -V /7^- ^ t '^' '^/>v r /JL,^
/t if>i* <>>w y/ J, / A /Taut ^j C&+Z+-K, _ _ £7
frfo+J? ta^wJL+tZ - Ti y 4^,0-. &i.* / ’fi~i,//zt^)
At *>*v^ Hj&* afL t*+**0 *« dA****~-L<~ *4* /J j /,
ii< ;~G *~J> ^^4 Ctfet
TivT ^ 1S5
V^ 4
l \. i —j
\%4/^r f^J
/^ /tU'/l / F
<^--/ !»>. ^ M .‘ afVl)
( 183 )
SOLUTION BY INJECTIONS.
Gases to which it is applicable.
Agents employed as solvents.
Manner of using them,
1} angers.
Utility of the measure discussed.
LITHOTOMY.
L Catting on the Gripe or Celsian operation.
Cases to which it is applicable*
History of the operation-.
Anatomy of the parts concerned.
Manner of performing it,
Hangers.
Utility of the operation discussed,
i
2. The High or Hypogastric operation.
History of the operation-.
Anatomy of the parts concerned in the operation.
Cases to which it is deemed applicable.
Supposed advantages of the operation.
Dangers of the operation. —~ 1 . Peritonitis. 2. Extravasation of Urine,
ft. Wounds of the peritoneum. 4. Lodgements of fragments of the stone
5, Hemorrhage. 6, Urinary fistula.
Instruments employed.
Manner performing the operation.
After treatment.
3. The simple Lateral,
History of the operation .
Anatomy of the parts concerned, in the operation.
Cases to which it is deemed applicable.
Supposed advantages of the operation.
Dangers .—1. Peritonitis, 2. Extravasation of Urine, 3, Cystitis. 4.
Hemorrhage, 5. Inflammation with sloughing. 6. Incontinence of Urine.
7. Fistula. 8. Wounds of the rectum.
Xnstrumejits employed,
MaUner of performing the operation .
After treatment.
4. The Bilateral,
History of the operation .
Anatomy of the parts concerned in the operation.
Cases to which it is deemed applicable,
Supposed advantages of the operation.
Dangers.
Instruments employed.
Manner of performing the operation.
After treatment.
i
( 184 )
5. The Recto-vesical,
History of the operation.
Anatomy of the parts concerned in the operation.
Cases to which it is deemed applicable,
b apposed advantages of the operation,
1> angers.
Instruments employed.
Manner of performing the operation,
After treatment,
IATH0TR1TY,
History of the operation.
Cases to which it is deemed applicable.
Supposed advantages of the operation.
Dangers.
Instruments employed.
Manner qf performing the operation.
Treatment during the course of operations.
LITHONTRIFSY,
History of the operation.
Cases to which it is deemed applicable*
Advantages of the operation ,
Hangers.
Instruments employed.
Manner of -performing the operation.
Treatment during the course of operations.
STONE IN THE FEMALE,
Symptoms.
Operation to be preferred when an operation becomes necessary.
Manner of performing the different operations ,
HYDATIDS AND ENTOZOGA OF DIFFERENT KINDS IN THE BLADDER,
Varieties.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
IV. AFFECTIONS OF THE PROSTATE GLAND.
WOUNDS OF THE PROSTATE,
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis,
Treatment.
f/iWC' — /?-*'<^* *4
&*?tht4 fU*U*L~ _ ‘
O
(y\Asis^t/t- fc£tAA/&*y4 /*-*•*■■^'tst****-*, ^ A&L,
fove, JkAwkJ l# y:
—■• - S^ic* £, i .^'CL'i'p--H^t.^ -^-t-
/2i~&6c4£,~ c /y^> /r*y,. j 4 ^../
/^~£s& y $2 —- b« 2^ <£2<^ ,^wf^
**- £&* m -<£~
'^d/C-t ’hJL*' C-i*, ^ £rty\j »
I /^ ^tV - <d(/jtCZ^-y Su2&Z*&-
$}**&*-* ^/2i- Ssti~£&?*$c &v£j£ 4LJ
$j? J^es*~ O -* -2 <£^w w
w* (/ t'V St J) » i '• v t. &"Y^L4*
iSy
*»
£Vr* ft^t/7^ &-*• sy-Ci
Ms% , ££, ^ _ d£<r**TL~ t >s£ < j /fCZ
f / ^]' 1 'U^£}-/.-i: ^/ £Lr(s *-(_ ■/
*~~fy C^&ZZ.S<j Z.
/O^h^i/i- %.■£-- L-o o^-c^ -* . S-c
A$l*J U- ' ^i*i^^ i**S**
&Cf -ify\A^ 3 ^-t) .- rV -'/iw
<t^^y 0^1*4* h> A^crtci&ji
t*jf)-tvU-<} >t%c fyjUi^-<A ^<^ 1 2? by - ' /.
k^'rtCUjs LA~~ -kryii/s t^CU 4 oi ^ & C ii Jj
^ ^ ( jr ^
caA
fiv&c.*-
» ^ at : **v
*s ^
/y*■** ^ ^
^ J&>l$hd+*,- ~ ^ 4^-Sv '***s&-/Ucr
4-*£**.i&* e - ^ p*^) x .
^«^V, Mry^*r-u.*^ iH ? «*y5rrrr -4> / J/ 7
'/
bL^Jzz luZubd^ /t
'/?. At. ^
^ ^
/ *4
^”2 \ 7&Ab$^*\ <&' T*- -f \. ; ^Tj
ln-t ^ Jk* fy^et-Tity , * /
fs/l /j^p*:i.at-ft~fyy ~cj^C^ ^ 7 77~/£~PC~i7£-. >Ti /cv/ J^
J5* ^ 7t *“/—/ ■ypv*
h-trt'f* _^4-/ ts s*^; i^c^'Xt'd^4~c%i A — - - _ .- _ r _
£j — A^~e) <>~i^~uJ ^
P^7-n£ fiTZT- a- £€*££++*}/ V**~ f"T L / ,At- pl^t^'-J-i'*- ^-y /2C?
/th f-z-c, Aba^, i*uj i*,gft, TL — aTl/^Cl * Afjr>
1/
P
^bat<* it^j **.£//, *•*-- —. ^*7Ct, * SJJi
'^■//^i f ^ ^ Ai4^y /2tl(i-%. /5'
^Y lN ^,4/ /> t£ % y-T tA +£■*■
jp>zc>- )C^ ^ f/^yj l. Ct.-s* & \s /i ,'^fo'—
A ' 1 “ AvV <V^ ) ^ J> *,4-A^#-4A.*-et Lf kiu//fcO
}j $£*■ /L * t Uvt la t ft $ /LL 4f±y_f hr** b ‘ J-7[£~ A A
l mcMs i; o/aXiAoX f^a-atMcK jet <LtffiiL $ v n-u'i^ in*. ->
hhd fi^l Hy cell . t'ifas j-hjx&c) u^'hj ex, dftS/yi 'ic
V U j /wj Tti {fi t (oiU . h fl it htJ s&hM*
lsJ-£4^ /Ch^/c a*i ( pd~'£$7uL Ch<J. ^ ct^lu Ttui yu< c
* w * A*ltot*sL
Wu-t^fli t> f *X. Jic % it di&4 b v^4 z -'S+.jb^y'f t LJt y..
^■,i v 3- jf'st +k SyCv&UZ..
— Af-— t<£ ^l-'&J'Tl ' "***/^
aJ i?i^<L.iij'7k£- \&M.4tJ>6r~ $ Jhrtti, tnti^u
^ falu-d ^*v-^ ^ C-tyJUc <c//v (inn# —
Y^ 'UTt) lu J(i L<f&(.-^. ^ h>7kJ',f^t^%
U i)a ~f7L tla\A>^ luv jvvj h-Huil i- ct,CU\ ~ 'tie'}\ ^( LitZisO /
v“> 73® W^p
ftJ ^ IJ (/N 4t/r>^
l>
3
% :
WVp^ 4 V w '—" ,-^ y
fc p
^ tot, ^@£*^9 C&^t
^2^7 ^£gtsts wicP
y&r^^£~sZZ^
"H
Cl*i t* <&*- £ < t/ ftZ^nr^frptv jtf ~J$LCs M &£j~
i itsj^ 'i 7^*7^ ■ CF<^/ ffizJt- dhUr$*#*t--t fc/^t j |
- 4 ^ '^Vv^TCv 44 &l£h * ^ ^fCo
I <y *^T £$Lt-%^ irf^ZfZ- 4 1 ^ £ *
£z3 <^/ *L4**- £, y y ^
^ J^L^s $Zdt*yr.£4*t J ^ ^ V ^ ^P7 %>L t 4
l *-£4~<- £*^Zo £ ^‘}t-i i_Jt f l
** +%*>£ t *r / C?
y^W $--iZD : yp j'4 < f *.
<4^ /t~* Zfg * ff^^inZZ^ _
(k Zc^lAu^t £$ jflZpH -t/^rA^I &T td
a&c/&*
£ ^ * &tsr* v g*^u4y $/^ I
i&r/t-t/^-jf’tY ^Jz^u^ZZ<Y^<s t^P tstyy I
&mZ£j €e±+t*~e J s^<&> &y&? ^ f $^A»^hr<* ^2yv*w <f / *. ^ /A
Zy? * i
fZy Zj’^jL-jZ l l 't-S «?.... * v
ffifr-fzfT tfbltJsdu’V #44A£~7& t f P4f&*«* I
$L$ dcr fa^ /Ct*v'-ttUi /tw/Jt.
<2luvZfS .44~^X C J ft-*- :. fz+H*, gUii e 4£*;S 7 Vf > ^1
£*-4sZ&CAJ tettZ/Zts llfri'fXjf &?- Zy ft *. £±y Ive-L rz. c.j
&&t+*xJ / $ Z/h 1 ^ £ fTTf At * y ZA^^
j(j?fcZt*rr U&t fc tl&fr&fd d>dZ'e> il&cjfz f-*cutZZt+Q -I
JCt^ cfi^f i i'i* ^ z_ t j£
&t*i****-^ Ctyt^ Zz 7/ / ^ ^ ZcZtZ&cc*^ ,
77 cfi &s/L p&s ££ 7) <fc*-*-£^->J _^ & f-u^<--< / ^r/ I
ficAf t*f t%\i, ■ylcfCtV-C‘-~//’ ! ;t **- fct Yr’ ■f.CjAfr'y-C &**$*?' I
^jw- jUffrtAo i:.£K4-t> : L ', f * :\&0~ A*jf Z^tA/fy f Z- ^-fp- ' I
[■its O t vt/ £,-/c<
ffjL ffd
bt ffe$, tt<^, 7/u, ^?u-
7*" £*'*€*■ c& t r .
£&r0l ~ £c^r+.
&£^t ^ P . /t3*c /-&
I /?; ^ Lgi^-vi'*- ^ e) &&ru*£T£> 14 ? & ^ ^
(.&Thct%*0 ^tt* CZ~Srt* &?h
l'h, tt t '*Kc £ tx^ iC*> A#**# /lc& .''V t) —
^ 2* &&*- ^ 7& ^
^ t * <*Lc£e~ ez£.- 14 4M)\t^>fru^) ' ^/sr^c- A^tMZ'
tL- ~ At ^ v<k ‘^. /tu-dl - '6-£i*.^£&£c-t* ffij&-‘ dfoufau^h-
S$ $i44d$pZ&*
„ , ^
. ^ -r~ /i_ v • •■'••Ssfc
y4:?*^J — f) +r ^5-tl y/^|
fut^rjia^ ^ «<«S£0 tvtrfc MU, Mi- 04-
~/^^p K*h
^C-t-4 X ^/2t^) /£n_is^-ts
t'} 7)\ **-•£ &&%-» At +i^-'i- 3t<-' / /v-jf t v j ,***}. ^/^/'>t^4L&
~^Ccs 1 >£*- frt'tZA'l tf~t.O /&VZ* <£
jf*T <^fe^w 4
/!
,*2 /Uy
VI*
-- (>^ , ^ t 't«'V
i*4*+y ^ £Z*4>-xZ) d'/'fZU'tf
\^*Tf 4&*C£) U y^-r^M ^
| ^ 'O' jXr MH.YC y t ^-w^c
Un*~H4y ^ "hx-ZZX **3KZs
Jlru^A**.*.. *J £^~—
£* =e -**'4*Z-'t> X, *-*d- &?
i tfetZi&fcZt} taut i^td —/o, ,/t^-i/)^
/4t sp/
h*-tj^^ /i,t*i* TtCt, .'J/tZts e ^
\/if?Lt»w a^y^/~c/'~jpCc> &2ZZ* h '•#'*-* / <3u.^Z
b^udo^o ikl frZvuidc* d
'fit* 41 * h H r L f ft* tj^S^ ^ /
^Uvf iuo^w^ Avc^>
/_ |>7V^c£^Jw<) ti~ ~ ’
/
cLtsiJLi^iu- Aszr>is*~*) '''jj'
* A - L - ^ y-L vl ✓ Z ' .A ^
/h^ZJ
^ / A-Cr^C*
-■*?,
7
JtLocjfP sns AU*. - ftiZZZZ /2-c^< l -&&d~ l L /fZfc
jHcyc-*i ~/h*, &dfclU /t^» <ii f • *» he+*--c- A—
^< 52a# 3 flC»t»« ^frt. c«^i£ ~/k^- ^*-^ww •— *t*
S- altlflLA^ th*- /scZt, c/fas <L-€- ^7 £5S*^46^*£.
/^C>4*£^ j?l£?~er jb*$i+Z £<-^ZT~'/C-^xy^^
I ^ P~*~^<^V4-Zt & £f~Z C"€*€ x3 I
'J f£ I
jfc £*+ & ih~ I
► i^hfa<--d^u w. xsd 'Cs ' foi- ia,^ cZL. ^ ^ /Cl I
^ 4 .//^ </" aw //r t *.-hx-t* t <J _
A, l<~£+u &A.to A (f^t'L-& J~j/j[ I
A^lSt) £*?*■**—-c* T^u**^*'
/w H-tJFZ*.y cz^tt&t 'T^tW ^£**#*i-*«— I
i^ Av t t* ' *c.<S'- kL'jtiZj&f I
/ *£&K*6-xCc*' At+-~i) jo U^. ^Vv I
t'CCfT** S‘C-t +*l) £~-Cj Jj £y ) |J
clrvtAiJ ^i^*«4v(/tw/"" i££t* I
Au^c^c*^ ^''£>'et-i- CT /4*<^ ^t-i,*-^ f A*~C-t^ — I
A.*.„c//> tvuuQ tr-^TtZ
A+*d &JL*£^+t£ y)rh<.T t~ 4£/>\^-' w I
i*C<*L, £-64'£ ' — fhAv-c^. ^irK-fi-Co- tpitJLZ’ 1
(C^h tZ £<l \^tZ^ <tyi^ faX-tt&c. cx^&. a/wv-I
/ / 1 I
$ 4 +^ l*u- c <_ ^ ^x*u£. —,
A'C^O fy-C-Au ZJ(s6 ad-et* u
(^- c-ttuA-o uL e*- c> h 4 *^-uca) t^utZ^ Uu*^!m
l/sfi.*~ tu'-'-X'l ^<Jr tMvl CUM-
CoiA^ 'VvvA^j ^u/jj/rV** _ j£M*t ' ' { ^ 1^ pv‘
fT\^ J^t/'»^Vw\ •— ^*^<3 /(IH v~-Ct ^ >fi-^,ci. 11 tv^Jd
/Crhy^j — "ft^t/ j*st* <-/f.-*> * •;' r
^-hrv^Z£> — Q^LrftuA. c, %*. *jL jp ^_y\
ijS *zr?.Jtr*p *r/r<4i
•f^l
h Ay
ft it- ' J?*&*»*£
Sh&hJS’ 1 *&* i '*i<>
fov+'-£*p r < r &4*lZ
ft*'*-*—r < 0^j. i ^- l/ A ri .
7to‘ /tu.'t fl
( 185 )
ACUTE INFLAMMATION OF THE PROSTATE*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment,
Cajise#.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
ABSCESS OF THE PROSTATE.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
ULCER OF THE PROSTATE*
CHRONIC INFLAMMATION, WITH ENLARGEMENT OF THE PROSTATE.
Causes.
Perso?is most liable.
Progress.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
CHRONIC INFLAMMATION WITH ATROFHY OF THE PROSTATE.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
POUCH OF THE PROSTATE*
Causes*
{Symptoms *
{Diagnosis.
Prognosis*
Treatment*
ABSCESS IN THE PERINEUM*
Causes*
Symptoms.
Diagnosis.
Prognosis*
Treatment*
VBINARY INFILTRATION*
Causes*
Symptoms
Diagnosis*
Prognosis*
Treatment*
BEPOSITES OF LYMPH*
Definition*
Causes,
Symptoms.
Diagnosis *
Prognosis *
Treatment*
FISTULA*
Causes.
Symptoms*
Diagnosis *
Prognosis,
Treatment *
NEURALGIA*
VI. AFFECTIONS OF THE URETHRA.
Varieties.
Causes*
Symptoms.
Diagnosis.
Prognosis*
Treatment*
WOUNDS.
Causes.
Symptoms *
Diagnosis .
Prognosis.
Treatment.
( 188 )
HEMORRHAGE FROM THE URETHRA.
%
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
RUPTURE OR LACERATION,
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
FALSE PASSAGE*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ACUTE INFLAMMATION*
Causes .
Symptoms.
Diagnosis .
Prognosis.
Treatment .
CHRONIC INFLAMMATION,
Definition .
GLEET*
Causes —An improperly treated gonorrhoea—disease of Cowper’s gland, or
the mucous lacunae of the urethra, disease of the prostate; strictures; some*
times constitutional causes, as scrofula, gout, rheumatism, &e*
Symptoms.
Diagnosis .
Prognosis*
Treatment - — Astringent and alterative injections; the argent rut; in sub¬
stance ; bougies, medicated or simple ; constitutional remedies, See.
( 189 )
©OKORKKCEA*
Definition.
Causes.
Symptoms —I. Those affecting the part itself. 2. Those attacking other
parts from sympathy.
Period of incubation*
Diagnosis.
Prognosis*
Extent of the inflammation.
Products of the disease.
Connection between gonorrhoea and syphilis.
Treatment.
STRICTURE*
Definition*
Varieties — L Permanent* 2 + Spasmodic, 3. Mixed.
Most common variety .— The permanent.
Seat of spasmodic stricture*
Causes .-—Yary with the form of stricture.
Progress,— Usually increases very slowly.
Number , .—Y a rie s.
JCxtent, —'Ya r ies.
Location.— l* At the orifice. 2. Near the middle. 3, Near the bulb.
Surgeons do not agree, however, on this point.
Symptoms -1, Local. 2. Constitutional.
Diagnos is —May be confounded with gleet; diseased prostate; stone in the
bladder; hernia humourhalis; neuralgia of the testis ; neuralgia of the peri¬
neum ; ague, &c +
Prognosis.— Depends on the variety of stricture, the age and health of the
patient, &c.
Termination*—M&y occasionally terminate in ulceration and thus a cure be
accomplished.
Effects on adjacent organs*
Treatment.—, Mode of examining the urethra.
Different methods of treatment.
a* Dilatation, By bougies, Arnott’s dilators, &c. ,
b* Caustic*
Local remedies*. — c , Incision from within*
d. Incision from without.
e. Forcing the stricture.
f * Excision.
g* Catheterism,
h. Cauterizing with argent nit; to allay irritability*
i* Absorbent operation*
Constihuional. — a . B I ood 4 e tti ng.
Demedief *—■ b. Hot bath.
c* Opium.
d. Inhalations of ether.
W hen the stricture is impervious and the patient cannot pass urine, the
bladder must be tapped, but this should never be done until all our other
remedies have been employed.
( 190 )
Definition.
FISTULA.
Varieties, — 1 , In urethra anterior to perineum, 2 In urethra, and dis¬
charging through the perineum,
Cathes. —Inflammation and abscess, wounds, &c.
Symptoms.
Diagnosis*
Prognosis*
Treatment .—Remove the cause, if possible, then use according to d rearm
stances the catheter, caustics, suture, indsion, blisters, plastic operation,
CONTRACTION OF THE ORIFICE OF THE URETHRA*
Causes.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
’
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ORIFICE TERMINATING TOO FAR BACK*
Varieties*
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
TUMORS OF THE URETHRA*
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis,
Treatment.
PAINFUL TUMOR OF THE FEMALE URETHRA,
Causes.
Symptoms’,
Diagnosis.
Prognosis.
Treatment *
HARDENING OF THE FEMALE URETHRA*
( 192 )
Varieties.
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment;,
BENT OR DISTORTED PENIS*
Definition.
Causes.
Symptoms.
Diagnosis.
Prognosis,
Treatment.
PRIAPISM.
Causes.
Symptom*.
. Diagnosis.
Prognosis.
Treatment.
INFLAMMATION OF THE PENIS*
* / '
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
ABSCESS*
Definition.
URINARY ABSCESS*
Causes.
Varieties .— The urine may be collected in a single pouch or cavity, bounded
by adhesive inflammation; it may be widely diffused in the cellular tissue; or
it may be mixed with pus, forming a urinary abscess proper*
Causes *~ Perforation of the urethra from wounds, ulceration,
Symptoms,
Diagnosis.
Prognosis *
Treatment.
Varieties *
Causes.
Symptoms,
Diagnosis,
Prognosis.
Treatment*
WOUNDS OF THE PENIS*
*
* - *
y/u>
(Hc^A ck ft ^
rfnuisusltS tz^J) '. M c
~ *AdQ^ ft ^^T ££ 2 —
C&U'iclhl^//£ fU^Q l >ix &-
[ c/^ l<^xft4c£ L>v*tsCz> cTlA / u / / -C /' ^ l ' i-
Definition.
Cause#.
Diagnosis.
Prognosis.
Treatment;
( 193 )
(EDEMA*
Varieties.
Causes.
Symptoms*
Diagnosis.
Prognosis.
Treatment .
Definition.
Causes.
Symptoms.
D tag hq s is ,
Prognosis.
Treatment.
Causes.
WARTS*
SHORT FRENUM.
Diagnosis.
Prognosis.
Treatment.
CONTRACTION OF PREPUCE,
Causes.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
PHYMQSIS*
Definition.
Causes. —1. Congenital, 2. Acquired*
D egress.
Symptoms.
Diagnosis.
Prognosis.
Treatments \ aries with the cause. In congenital cases an operation is
usually required, when produced by accidental causes s we should never operate
without a due regard to the condition of the parts.
Operations.* 1. Slitting up the prepuce 2. Circumcision. 3. Division of
external portion, the mucous lining being left entire. 4. Lisfranc’s operation.
Removing a semicircular slice, 5, Velpeau’s operation. G. Removing a triangular
piece.
Operation to be preferred.
13
( 194 )
PARA Pli Y MOSIS*
Definition^
Causes*
Degrees*
Symptoms.
Diagnosis.
Prognosis,
Treatment.^
~l. Compression. £. Cold. 3. Operation.
Definition.
Causes.
Symptoms*
Diagtiosis.
Prognosis.
Treatment.
BALANITIS*
Definition.
Causes.
Symptoms.
Diagnosis,
Prognosis.
Treatment *
POSTHITIS*
Varieties.
Causes *
Symptoms*
Diagnosis.
Prog7iosi$.
Treatment.
SIMPLE ULCER*
Definition.
Causes.
Symptoms,
Diagnosis.
Prognosis*
Treatment.
ABRASIONS*
Definition.
HERPES PREPUTIAL IS,
Causes*
Age most liable*
Symptoms.
Diagnosis.
Prognosis.
Treatment.
1 ■
■
*
( 195 )
CEDEHA OP PREPUCE*
ADHESION OF PREPUCE*
LOSS OF PREPUCE*
Effects to which it gives rise.
Treatment,
SYPHILIS*
Definition - $ v (mutual love,)
Synonyms*— Lues veneria, venereal disease, morbus gallieus, pox, &c.
History, — 1 , Was syphilis known to the ancients? 2* Was it imported
from America into Europe ? 3. If not imported thus, when and where did it
originate?
Causes, —Supposed by some to occur often spontaneously. Impure sexual
intercourse, (See Skey.)
Period of incubation.
Question of a special virus -Broussais and his school, and others also,
denied the existence of a specific virus. The experiments of Ricord, Parker,
Carmichael, Mayo, Wallace, &c, prove the contrary.
Does gonorrhoeal matter over produce the primary symptoms of syphilis ?
Classification of Syviptomu-*—
1. Primitive or direct.
2. Successive,
3. Secondary,
4. Tertiary.
5. Diseases unconnected with syphilis_
(Ricord,) or
1, Primary or local.
2. Consecutive, general, or constitutional.
(Hunter.)
Causes.
Symptoms,
Diagnosis >
Prognosis,
Treatment*
Causes,
Diagnosis*
Prognosis*
Treatment*
Causes *
( 196 }
PRIMARY SYPHILIS*
CHANCRE,
Definition.
Mode of devdiijmtiti —1* Pustule. 2. Ulceration or abrasion* 3, Abscess.
Physical character ,—Varies with the location } number, degree of in flam na¬
tion t duration, fee*
Character of the pws*™Varies, and is modified by the stage of the chancre.
Stages of chancre —1. Ulceration, daring which the matter secreted will
produce the disease if we inoculate with it; it may last several years, but
usually only one or two months. (Ricord.)
2. Granulation and Cicatrization* The matter secreted now ceases to possess
inoculable properties.
D ivis ion _1. External,
2. Internal, larvated or concealed*
1. Follicular.
2. Indurated*
3 Phagedenic*
4* Furunculus.
Seat of chancre in the different sexes.
Causes ,—Sexual intercourse,touching a chancre; during labor the child may
be inoculated.
Diagnosis,— Often difficult,
Progjto.sis ,—Varies with the form of chancre. Chancre produced by artificial
inoculation ; characteristics of—(Ricord.)
Prophylaxis,
Treatment of chancre —1. Local. 2. Constitutional*
Cases in which mercury should he employed.
Cases in which it should not he administered.
Extent to which it should be carried *
CONSECUTIVE SYPHILIS.
I, BUBO*
Definition,
Causes.
Symptoms.
Diagnosis *
Prognosis.
Treatment.
II, SYPHILITIC CUTANEOUS AFFECTIONS.
Varieties.
Period at which they appear .—Sometimes along with the primary symptoms,
but generally after these are cured*
Parts of the body most liable to be attacked.
Symptoms, —4* Local. 2. Constitutional*
Diagnosis.
Prognosis,
Treatment *
' y'L-c^XZt,/2~ /i n - Lj
4w) ^ _
V\JtA)&u t/y dAAAy/x j
UyiT>y}- Kc-<xA.
< f r\A~"£K (—
&&z) ls/3n u
At
b^LsCSrt-tj /£* £<4*C
O^tSl^' i~/~y~t?~i b-' >'-'* —- <~st La-4.
J*nAO /fr-A ^//U^-c^Ac^ CZ^J/. &c.Ju
J, OZ&I t-i^Ay /-X^
iCc^d. - <ylsc)f{ dtz/ rdt^LjleQ- /*,
.^jd-^-t-i* )/ ■Jr*d C-A ■<■ '^•
/^T^S--*-'■<■'' ^X-A>' ~L-Z(, ,. /^y tCj C-rH'-A?^/
'^ /, '' z ^*^c s / tu 6'n.*s*-* ynfT-n-u-^^/ .
V ^i-dd-t- *-■^'£3i-'t- ~ ■ yfc- ;. A^t'^Cy
r J- - y /OAvn — ^^■-J’ALi <-■/• fh'<-'/-''r-&~y -i
■<-£_/ v /. /y ia*/ f ^ ir< s y? A~C'j£.// f)
<zi
ZaA'fc- W - /fc^t-r /,
by. A'iS~t)
(^K^MjuV 3-
~ « ^ U-
$U-«-OW ';^C'-^-'
l AL / 4^ / C
/' ^i^^A-A (*<y yftjf' l ''<-' - 'J fi
A i 0~f £ d *~Cr *-A Jt J? -
-- ,. . -7
gs&cS-z.^^ __ Ay
ca -~~ ^) Zt'iA.yyf^i y\ ;. / ^r?i -^-v
,
Av
X-6-
—Ay
V ... ys 4 z *
c fV / / / .x
■- ff^--/i-t-'£ / ■-
L ,{ Z< ^ r /h^ < ^- -r-u <^ f _
.
;•• /i# v- /■'"'/’ u • / ■'
/iT *d<~L C*-~~ S'A.'$..y / 's)_. t L
C' ^ /p+*€ t CU'Y^
ajUa ., ^ - - p •: £ _• J
^ t*sC{'i \ -- ts- V^O ^t^sjrfriLtt
' yOv dhj. --- •"■£ f-.r-: dbl LU:j &*y> c.- A^- /y - :
.
^ ^*^2 A4 YtU<£*,-6*uAt U :
• ’ ‘ "X *-<*^ — 9'> ~ c «'l $uc £jrv^„_
'W*^* 'J-f » ••» wr^p Vtw. ,
I jp^'^ &f^(st“l y ,*£ 7 [. /.^M LL^&'t*
/ XL ( - * f /- / / jXif'i /& t* t
L f i t- ^ g) / 4 J* , ^
-
_
f'Ct-^^ • y.: ’ ; t- • • • •’ ^ < Vv3vi^^ X ^Wt?
rUc*^ _. , 0lJul^
^'OO'tth Cl-V^lL jJ/tH t^y
Am- ,
(hnxtJl _ kc-c^-el or ifo
&1- -1— A^-v."
^Wt _ ^vja^-c- ^SomXc<.-
ft try* w- y •"* »^»i
//js^w / 1 -tv 7hA*-^ h^ _ fc
w O Lsi A-<S\*tS /1r\sL ^cAfut <Cr'£^~
- &<%- &C J& ^CU 1 ^^—~
/^t yL t**c&'f&zf //< < t ^ Al * i *# AV^ ^0 ^., . A
^A -J\ lM
W J_ /,jf^t i j t>u_ O^j /
fiU, x/t- fv-L/L^ j .
ttU *4 - O ^Axf'
,— /a A
J^f^Y Ov^/ Ko’.x-'^k, 17 5 ,
-. fvL 7 ^a>cc V-AL'a X)
WvvUd
. __ ^__ _„ _ __ , ,^y>vv^y 4
fyoi^iu^y ' ^haA^j At -£Avu~ Jj^x-i.
/t\A^t/) ^ -6 V /IatIW''® ^ Wy v Aj
SU^jpAv C't/>\A' ~" btC^'l^. (7-V- rjr ’^' _ / - [ma^ Awt)
hv /W
u
( 197 )
m* svphilitec sore throat*
Period at which it appears *
Sympt ome .
Diagnosis.
Prognosis,
Treatment.
IV* GLANDULAR DISEASE FROM SYPHILIS*
Glands most liable ,
Symptoms,
Diagnosis.
Prognosis.
Treatment,
V. IRITIS FROM SYPHILIS.
Period, at which it makes its appearance.
Symptoms.
Diagnosis.
Prognosis.
Treatment.
VI* SYPHILITIC RHEUMATISM*
Period at which it males its appearance.
Symptoms.
Diagnosis,
Prognosis.
Treatment.
Z) efiodiio n .
Period at which they appear.
Symptoms.
Z> lag no sis .
Prognosis,
Treatment.
VII* NODES.
VIIr* DISEASE OF THE BONES FROM SYPHILIS*
Varieties,
Symptoms.
Diagnosis.
Prognosis,
Treatment,
IX* ALOPECIA*
Definition,
Treatment *
AMPUTATION OF PENIS,
Cases requiring the operation.
Mode of performing the operation.
CANCER OF PENIS.
Symptoms .—Commencing with a wart, or a tubercle on the prepuce, fre-
num, or glans penis, and often remaining quiet for years. Being irritated, it
becomes painful and enlarges, often rapidly and to a very great extent; ulcera¬
tion then takes place, accompanied by a discharge of sanious fetid matter; pain,
sometimes excessive ; constitutional symptoms and inflammation of glands of
groin.
Diagnosis. —May be confounded with venereal warts or simple tumors; in
its ulcerated stage, with sloughing ulcers.
Tissue affected.
Prognosis.
Treatment.
XVI. DISEASES OF THE TESTIS.
Under this head are included diseases of the testis itself; diseases of the
spermatic cord ; and diseases of the scrotum.
I. DISEASES OF THE TESTIS.
SUPERNUMERARY TESTIS.
Numerical increase. —Generally one ; three have been enumerated.
Diagnosis .—May be confounded with epiplocele, fatty or fibrous tumors in
the scrotum, or an encysted hydrocele of the cord.
ABSENCE OF ONE OR BOTH TESTES.
Diagnosis,
Consequences.
IMPERFECT DESCENT OF THE TESTIS.
Varieties —Where one or both testes have been detained in the abdomen
near the internal ring, in the inguinal canal, or in the groin, just outside the
external ring.
Causes. —Peritonitis before birth causing adhesions ; congenital smallness
of the external ring; want of power in the cremaster.
Consequences. —Depend on the situation of the testis; if it is retained within
the abdomen, no uneasiness or inconvenience is experienced, nor are the gene¬
rative functions likely to be interfered with ; if, however, it should be retained
within the canal, it is liable to compression by muscular action, it is exposed to
injury from blows and various other causes, all of which may interfere with its
development, may impede its nutrition, or excite disease.
Diagnosis .—May be confounded with bubonocele, &c.
Importance of correct diagnosis.
Prognosis.
Treatment .
( 199 )
DESCENT OF TESTIS INTO THE PERINEUM.
Causes.
Diagnosis,
Treatment
ATROPHY OF THE TESTIS,
Division —Into that which arises from arrest of development, and that the
consequence of wasting.
Causes —Of the first variety, imperfect descent, congenital inguinal hernia,
congenital imperfection of the hrain; of the second variety, inflammation,
injuries of the head, impeded circulation, pressure* want of exercise, loss of
nervous influence, excessive venery, and by some writers the long continued
use of iodine.
Diagnosis. »
Prognosis.
Treatment,
INJURIES OF THE TESTIS.
Nature of these .-—Contusions aad wounds.
Symptoms,
Diagnosis.
Prognosis.
Treatment.
HYDROCELE,
Division^—Into Simple Hydrocele of the Testis; Congenital Hydrocele,
and Encysted Hydrocele of the Testis; Diffused Hydrocele of the Spermatic
Cord: Encysted Hydrocele of the Cord ; Hydrocele of the Hernial Sac ; Hydro¬
cele of the Female.
1* HYDROCELE OF THE TESTIS,
Definition. " .
Varieties -Single and double.
Characteristic offluid .—^Its nature ; its quantity.
Predisposing causes .—Age and climate.
Exciting causes.— Inflammation, obstruction of circulation, inguinal hernia;,
strains, or great fatigue, blows, the presence of loose bodies in the tunica vagi¬
nalis testis, and disease of the testis itself.
Symptoms —A pyriform swelling, elastic, and fluctuating, transparent,
movable but remains constant under pressure, little or no pain*
Time required for its formation.
Situation of the testis.
Diagnosis.. —-May be confounded with scrotal hernia, or malignant disease
of the testis, or varicocele, kc.
Mode of examination.
Prognosis.
( 200 )
Treatment, By external remedies and by operation; treatment by operation
is either palliative or radical.
Nature of external remedies.^-Cases to which they are suited. '
Palliative treatment by operation —By tapping ; by acupuncture.
Period required for its re-accumulation*
Radical treatment by operation.— By incision; excision ; caustic; tent;
seton ; electro-puncture; and by injection.
Operation to be preferred.
Apparatus required.
Rinds of injection,
Dangers of operation.
Advantages of.
Complications —Encysted hydrocele of the testis; encysted hydrocele of
the cord; diffused hydrocele of the cord; oscheo-hydrocele.
II. CONGENITAL HYDROCELE OF THE TESTIS*
Definition,
Symptoms.
Diagnosis.—May be confounded with simple hydrocele, or reducible scrotal
hernia.
Prognosis,
Treatment. —By truss and by injection*
Dangers of latter.
IIL ENCYSTED HYDROCIlE OF THE TESTIS,
Definition.
Structure of cyst.
Situation of cyst —Either beneath that part of tun* vagin* testis covering
the epididymis ; between the tun* vaginal, testis and the tun* albuginea ; or be¬
tween the layers of the outer portion of the tunica vaginalis.
Usual situation .
Nature of fluid.
Symptoms.
Diagnosis —May be confounded with simple hydrocele.
Prognosis.
Treatment ,
Operation to be preferred.
IV, DIFFUSED HYDROCELE OF THE SPERMATIC CORD*
*
Nature mid seat of disease.
Symptoms.
Diagnosis.— May be confounded with an omental hernia, an encysted hydro¬
cele, or varicocele, or retained testis.
Prognosis , —Fa vorab le *
Treatment.
d s' / &> ,..
7y/U *$*?■'/' Me £Mi4L ahrtJt-
Me tfuti day Jvz ffL ^ fes&U'riZZa
I ^4W #dy~uyda^ yc^ja,^ a?t fpr d^
J S'MyjJ^ yd pHCdtdtr At>+- j. w dkJrtdd /
1 * /&? y&f&'fi/tinzn a** <z~&J -~r yttn erf
I s> M/?n fQ&yycjrfuj Qtti^^jyd
\ /#***J~ Aud<p* - vftfcdh* a
Ac Ai ^ AP&**~y- <U&ty fad&fol
m
{ 201 )
V* ENCYSTED HYDROCELE OF THE SPERMATIC CORD*
Definition.
Age most liable.
Nature and seat of cyst.
Causes.
Symptoms*
Diagnosis .—May be confounded with simple hydrocele or with hernia.
Prognosis,
Treatihenp .—Palliative and radical by operation ; operation of Mr. Hey and
others.
VI. HYDROCELE OF THE HERNIAL SAC-
Definition,
Causes _Congenital and accidental.
Diagnosis .^-Moy be confounded with simple hydrocele, or encysted hydro¬
cele of the cord, or with hernia.
Treatment.
VII, HYDROCELE IN THE FEMALE*
Varieties -Diffused and encysted hydrocle of the round ligament; hydro¬
cele of the canal of Nuck.
Diagnosis*
Prognosis.
Treatment*
HEMATOCELE,
Definition.
Varieties .—That of tunica vagin. testis, and that of the cord.
I* HEMATOCELE OF THE TESTIS.
Varieties .■—Where the extravasation takes place in the healthy state of the
parts, where it succeeds or is combined with a hydrocele.
Causes —A blow or strain, or a wound of some vessel of tun. vagin, testis,
testis itself, or of spermatic artery.
Situation- of testis.
Consequences*
Symptoms.
Diagnosis ,—'May be confounded with hydrocele, chronic enlargement of
the testis, extravasation of blood in the cellular tissue of scrotum*
Prognosis.
Treatment.
( 202 )
II. HEMATOCELE OF THE SPERMATIC CORD.
Cause*.
Liability of occttrrenee. —Rare.
Symptoms,
Diagnosis,—Mzy be confounded with diffused hydrocele of the cord.
Prognosis —Favorable.
Treatment.
ACUTE ORCHITIS,
Varieties.— Primary and consecutive.
Exciting causes -Contusion, compiession, great excitement of the sexual
organs, metastasis from sali vary glands, an inflammatory action of the urethra,
Predispo sing canses Sc rofu 1 a,
Symptoms .*—Local and Constitutional, and vary with the form.
Diagnosis. May be confounded with strangulated inguinal hernia, imperfect
descent of testis, &e.
Prognosis -Generally favorable, varies, however, with the cause.
Consequences*
Ter7}iinatio7is .—Resolution f hardening, suppuration.
Treatment -Leeching, venesection, cold and warm lotions, purging, com¬
pression, &c.
II, CHROMIC ORCHITIS,
Anatomical characters*
Consequences*
Carnes -Slight contusions, venereal excesses, masturbation, urethral dis-
ease, syphilis.
Symptoms -Usually of an indolent character,
£ Terminations,* —Resolution, suppuration, ulceration, sinuses and formation
of spermatic fistulas, hernia testis.
Diagnosis. —May be confounded with carcinoma of testis, hematocele.
Prognosis .—Generally favorable.
Treatment —^Chiefly constitutional, mercury.
TUBERCULAR DISEASE OF THE TESTIS.
Seat.
Causes ,
Age liable .—Barely until after puberty.
Symptoms. —Insidious in their approach and indolent in their progress.
Diagnosis -May be confounded with chronic orchitis, and malignant dis¬
ease of the testis.
Prognosis.
Treatment ,—To n ic /
CARCINOMA OF THE TESTIS.
Varieties -Scirrhus, Eneephaloid, Colloid and Melanosis,
( 203 )
I* SCIRBHUS OF THE TESTIS*
Frequency of disease .—Very rare.
Beat —The tubyli seminiferi, the epididymis and sometimes the spermatic
cord.
Symptoms .—An enlargement of body of the testis with great weight* and
severe occasional pain, feeling tuberculated, irregular and excessively hard.
Diagnosis. —May be confounded with chronic enlargement and with ence-
phaloid disease.
Prognos is ,—U n fa vorab le,
Treatment.
II* ENCfi PHALOID CANCER OF THE TESTIS*
Synonymes -Pulpy testis* medullary sarcoma* soft cancer* fungoid disease,
fungus haematodes.
Age most liahh .— No age is exempt* hut it is more common at the middle
period of life.
Symptoms.^ An enlargement, with induration of the body of the testis*
which preserves its oval form and even surface; slight tenderness, dull pain,
and occasionally a little effusion into the tun. vaginalis ; as the gland enlarges
it becomes uneven* irregular and tubercnlated, also soft and elastic; pain
increases; spermatic cord becomes thick and full, scrotum is swollen and vari¬
cose; glands of neighboring regions become enlarged and painful; general
health suffers; ulceration ensues* and a morbid mass protrudes in the form of a
bleeding fungus, and the disease makes rapid progress.
Diagnosis .—May be confounded with hydrocele, baematocele^ cystic dis-
ease, and, in its early stage* with chronic orchitis.
Prognosis.
Treatment.
Carcinoma of the Tunica Vaginalis Testis has been observed.
Diagnosis .—May be confounded with hydrocele.
Prognosis,
Treatment.
Colloid or Gelatiniform Cancer and Melanosis of the Testis are very rarely
met with.
CYSTIC SARCOMA OF THE TESTIS*
Syno nymes . ■■— Cystic Disease, Hydatid Disease, (Sir A . Cooper.)
Anatomical seat.-^ln the substance of the testis.
Number —From two or three to a countless multitude.
Size -Vary from a millet seed to that of a pigeon’s egg.
Nature of the contents.
Mode of origin. —Difference of opinion. Sir A, Cooper’s opinion.
Age most liable .id die age.
Causes.
Symptoms. %
Diagnosis —May be confounded udth hydrocele and ence phaloid cancer.
Prognosis ,—.F a vo rab le.
Treatment.
FIBROUS TRANSFORMATION OF THE TESTIS*
Anatomical seat*
Consequences. »
Diagnosis *—May be confounded with malignant disease*
Prognosis,
Treatment*
OSSIFK3 DEPOSITS IN THE TESTIS*
Anatomical seat. — between the tunic®, or in the epididymis.
Causes,
Symptoms.
Diagnosis.
Prognosis .
Treatment.
LOOSE CARTILAGES IN THE TUNICA VAGINALIS*
Causes*
i Symptoms.
Diagnosis.
Progno sis.
Treatment.
NERVOUS DISEASES OF THE TESTIS*
Varieties* — An exaltation of the natural sensibility of the part, or the irritable
testis of most writers, and neuralgia of the spermatic nerves.
1, IRRITABLE TESTIS.
Symptoms*^ No perceptible alteration in the parts, but a morbid sensibility
accompanied by pain* and general ly referred to one particular spot.
Causes _Constitutional, chiefly.
Diagnosis *
Prognosis*
Treatment*
2 . NEURALGIA OF THE T£$VJS.
Causes *—Disease of the kidney, the passage of a calculus along the ureter,
varicocele, orchitis, but often the cause is bidden.
Symptoms *—Sudden, severe, remitting pain, either of a lancinating or of a
dragging or pricking character, and is commonly attended with spasmodic
action of the cremaster, and sometimes with nausea and vomiting*
Diagnosis.
Progttosis*
Treatment.
i
Causes*
Symptoms.
Diag-Posis.
Prognosis,
Treatment.
t 205 )
HARDENING ©F THE EPIDIDYMIS,
ABSCESS OF
Causes,
Symptoms*
Diagnosis,
Prognosis ♦
Treatment.
Causes.
Symptoms*
Diagnosis,
Prognosis,
Treatment.
THE TESTIS AND EPIDIDYMIS,
FISTULA,
Causes,
Symptoms.
Diagnosis,
Prognosis,
Treatment.
FUNGUS OF THE TESTIS.
CASTRATION.
Definition.
History of operation.
Diseases rendering it necessary— The different forms of carcinoma ; Inter-
cular disease* cystic disease, some of the terminations of inflammation* severe
neuralgia combined with varicocele.
Steps of the operation ♦
Dangers.
OPERATIONS REQUIRED IN IMPERFECT DESCENT OF TESTIS*
n, DISEASES OF THE SPERMATIC CORD.
VARICOCELE,
Definition.- —A morbid dilatation of the spermatic veins.
Division into varicocele and circoceie not employed.
Appearances on dissection.
Testis most liable *
Causes ,—Anatomical structure* and accidental causes.
Effects.
Time required in formation *
(
( 206 )
Diagnosis. —May be confounded with scrotal hernia* or a congenital hydro¬
cele, &c.
Prognosis.
Treatment _Palliative and radical; Sir A* Cooper’s operation; RI cord's
operation; Sir B. Brodie’s by division of the vessels; Celsus by ligature;
modifications of operation by ligature ; Breschet’s by compression or excision;
Pancoast’s operation. The truss.
Relative value of each*
ADIPOSE TUMORS OF THE SPERMATIC CORD*
Age most liable.-** Advanced age*
Symptoms _Loose movable tumour, of a soft doughy feel and lobular
character.
Diagnosis. —May be confounded with omental hernia, or varicocele, or
hydrocele*
Prognosis.
Treatment,
SPASM OF THE CREMASTER*
Cause s ,—Gene ral ly sy m ptom a t i c *
Symptoms.
Diagnosis.
Prognosis.
Treatment,
III* DISEASES OF THE SCROTUM*
WOUNDS OF THE SCROTUM*
Nature,
Causes*
Characteristics of contusions.
Diagnosis,
Prognosis,
Treatment*
PRURIGO SCROTI*
Definition*
Symptoms,
Age most liable *—" Adult.
Causes,
Prognosis.
Treatment *
VARICOSE VEINS OF THE SCROTUM*
Age most liable —Old age*
Treatment.
-
{ 207 }
PNEUMATOCELE*
Definition.
CttUS&S.
Symptoms*
Diagnosis.
Prognosis.
Treatment,
(EDEMA SCRQTI*
Synonyms .—Anasa rc ou s hy d roc e le.
Causes -Mostly symptomatic.
Symptoms.
JMagnon$,~M ay be confounded with hydrocele, and elephantiasis of the
scrotum.
Prognosis —Depends on cause.
Treatment.
INFLAMMATION OF THE SCROTUM*
Mild and severe*
Symptoms of each.
Terminations of each.^ Of the mild, resolution. Of the severe, mortification
and rarely effusion of lymph or pus.
Diagnosis —May be confounded with oedema.
Treatment,
MORTIFICATION OF THE SCROTUM*
Causes .^.Severe inflammation, excessive cold, extravasation of urine.
Symptoms.
Diagnosis,
Progviosis.
Treatment.
Causes*
Symptoms.
Diagnosis.
Prognosis.
Treatment *
ABSCESS OF THE SCROTUM*
ELEPHANTIASIS OF THE SCROTUM*
Definition,
Anatomical seat.
Pathology ,
Causes,
Symptoms.
Size of tumor.
MELANOSIS OF THE SCROTUM—RARELY MET WITH.
TUMORS OF THE SCROTUM.
Varied*# met with —-Adipose, fibrous, &e. &e.
Anatomical seat*
(James.
Symptoms.
Diagnosis.
Prognosis.
( Treatment.
RESTORATION OF THE SCROTUM*
Causes demanding the operation*
Mode of performance «
IMPOTENCE*
Definition.
Difference between impotence and sterility.
Secc most liable —The male to irripotency, the female to sterility.
Causes of impotency —l. Organic, 2. Fanctional. 3. Moral,
Symptoms. —Depend on the cause.
Diagnosis.
Prognosis. *
Treatment ,
A* i
. 2. !0~ ft->3? - L&M»Cisu* r ftctr
frvtfeuZe*, K> ftsCb ^Hni'Z) 8-c H h,&LA^_
%3 iv hr {X ^ &*C'*&£i,y &+ e4**suM* ^s**-—
^ 0.^n£pw*j j£t*£> O-i^vU^u tKtd £&i£U7iZiu
^U/^w.,i^ucv - c*U (fajr Pfth fi*\i> ttjl tttZT nu^v^*-
fzzr tc& u. * frstS 'u, ^^*U*&*
^ v b\K\KX& i 4 tuw ^ - by Oja-a~ ~U (xt\yO Cu*Jc) (JjJ-nU
Ihyj**. tvtfe *Lvy ffii-o Pt^tsy, fty"i I
^ i** f htsft^ — Cusjz y $Jws*,6 ct+iM fo&t tviwv.
^(Yvjh-v) A-iA-l' j/~t I
&***& i'twvv i **+W—& Jofifa ***— fitAsl' /H,-t ^tr: ■ i t'tA^j'S
l U« £**-3 yl J*r*uc^ /ts*/£Z — I
• qj) Q./.Sty* y/ $ut3* 3-m. c“2^1%^ (*? *-£
&£**■'-£> * '// fif ty*- "H'&g &C&M, %Z A-*i& £.,* I
&-Ua^ 8y^ frfuirdr M C^rUutJ^ ' /? to y
DY^i'C? }<t/- i ~iM ‘ix&b £#t r>». ^ /L <)i' j'/t *<.
pN
chtH.k c w* clcJm' ?''
4™\/b * <j3\jLu ij^ui
**■&<• '^$■*■•• / [{£.£- M<L« I 1 )
■ ty^i {-&**&- • t s
<?*-.'< c
/'I**'
- • t •• <'*_ ti‘i-n'-t- 3v
{Vfo&x-j^ ~ffco j&iu) y ^£a^mh> & ^uJcstr^Za j^ _
•^■‘ i£tsl !-> f^Z £>
f /; / '<C &*tt£o (££A^J&U. si , t .--jr
■fC-Vus
f- -jt -*w Ia AZs £ttxZi.& &£ cs s/ y? /’Lm
ttt* <0 Jh ZTob * y Z-us
I t V U+-Cd y-L.U aJ
a^ ^ ^/ ?H4fr& It L £y~
<%'A / £&*%■*/ €■**■' <f'A /■'■■'t3c>
4 t&frli &J ~(~u4 {\-t t/h.At* ( sz£ct:ti Jj £c£v ; Usf'
i i y (/It*' c V ■. • /j — *-^^.>* ; <t -^' ’,. Ztsp^ £-v X“/~yjy
^Tke tOU tM*M> }*.OtjtZ£Z» hu*n
UwJy yJr fcjJr
XiyS^
f*U44&*-. $ tc* — «sa
i-&£& i- Af t >■< -*?’ c'i-^v w'//Ci' /&A«* ft /•+ Xhl*/- rp,jl ^gT^ t
I t-'ft£t-^ t t. ^-’ ( ' {,£ &&/£,
-U- <vuA 7t£* ■■' zfe
Ct* ■-) ,y 5V- «,.
&Tu7*Jh “^r/j oJXxl- TTvtTC c-^^X tJ St ^
£ i f*f' t -X- 3 c -]j T^ZiX -^hA/ fr. Af /fT}-{J <■ x.
^ r cuXzLS gr mL^uX^.
X 0*?*r0e£cr Ac a-# /X X&X ttZX
fe$Zck> 0l~J Jfy Xla^P^ X\s,
**' u-y , Thj lck:£ct X **-J —• ^trzsyu ^-a
tf»&Lf{U ^ ctZ/ $£u+ j6 A/Yr 6fft> />****?
£**? h &£££*Jo gUj |
dj^fLAsy^p- LuJjH X+£- <*/ <,A/C — (L-4- sf-j
^’e^H>UA?X *6jnU 3 4~ t hr out
tytrzr-3 A***-$'<. C's — f<*H .fl~t-fj X Ac. S/t+Tt -p
bcAjy~+. ^ ALA.i fft-rf. <c— q~-*^A.AA@ t tA£^A y *'
tsUr-tA$-L^e^A iy f 7 Ci, Xt^S &, X ,/xttf^
ft+XyC, /XxJj ,-}
& - ?T~~~ _ . , * rf -#r—- \
*- -.^r -‘”—-rrfcr^
J<iJ t'- /i'/ r V !.*-<) ft^r- jfrttg ty - / a/-?*?/ / / /*.j
' ft ' f /
An>i ?■&*+* gpy-^y ^ <Hw A*-&t*A* ,AU-> /('<AL
<S> yc.- a, teXxJv a*Al 1 ^x.6t*tc^ &*■<.£
lAiyU,, -w «(^Vf f /v C^fi
y<X
/{-Cr&AJ tf f <1- y^-cAcA*^ f~pt£~4 jLat+x,^
At.' I -t-:: . . J • -, ^ . t -u-
r t^c>
l . f
Gt'XX ^rU
h t£A4 (/s+4*~ bxrvMs C-C*^ O (MMqu,
‘ tASf Oc^J Avt^ ^ 3 ha^X Au^tt^c
&•-*£ IfM-CtuM^O ^-C~h,L4 ct&€lM4> Usfl
Ax, ~LM~t * <fA <^*aA~ lku« t< C-l' ^'6 ii / j
f
I it'hc^ZT fifvZfp* J^~ t +'-<&*4v- f^ -'{
SBS^asiftjtate smsS--*
fv£>£ %t-1 %?&.£?:
j frtsfaht* f A S%^ M&t^rc, _ 4Wf)
2> 7f^^L**A)
t r * * f 4 f s * i » ‘ ^
CffUs «- / k& t^ 1 H~(A> < ^-
jl ^,/ x!^/u &&'<-<- kc-<^ c£..jsy'~<~~' d Uy f^Cu
I —-
. x
1
;A
/
y
' y t w'' -A -d
*^y j ^ . .js
ft^
A
*1
7
4
' r &*vA*
/V *^ t *7 7*** & (fa jt Uh#,£
J" **•.. <?^£, //-Jt 75^1^StiV•<''/*■
Tfc
jp*f / -y,-^t_
<T
«^-du
«*?
4^^
PtA
***$ /&
M
/.. .*?■■£{■ £ v* ^2 fa d-W^- i
■ if £±/t*£+ c/ <£TC* &~'//Z*
* ^ Mir*-*} gt A y^C2
/5T- /£- -6
'r
A*' £**+■£*
A
<*s
jy* ,
A ^^ — Jg*& fh~y fa fa*-
✓ -, ^ . X . / .
■V
/S\,
A fa t/ fafai..
A-Tt/r
fa?
*v *Av ^ ~ fa iJfafa ##*
+* Ss.
>v> 4#^ JR* /-t.+'V-t*
A
^W;- y ^r r fa^ r fafa~ S
g^isfafa* ** A A -W^ «>,,,< i /W-d.
CL~j~i'Ar<~ i 4*A, fa* slfa. <*^a-c, c+*-**A) jLyfa
K "" '^L Ip ?/ id&*~2 fao /
_ \ ^ ^ A fa &tfa/C$fa(7
fj ^ ^ ^ ^ * 2_
Avto ^jo —• J.H, A-* v * * ^if-ftt,^ A ^iw^K-; jjfcvvt j&ffc)
%¥*v >M4vi^ «*■'•■■«•' 1>v\‘l titfyfrtn 2 .*)C C^*--^ d»*-
''•“^i'*’« >» —*. (f*-tv\ K t/y^ 4^.<
<-o-
fa -y-.t-r '* kv» t^wX^L H' ('v4rt'|^ +w t*v Arr^fafa^t-cs ^
^YtiAi W" /A«- M ^ 3-wA»-4>^f_e^) Af- ^ A’-
^ °fj 'j r ktt ^/ ^ Cn^'Co ufc ^ >^C
C-tr^-
1- 1 6 ^
M,
h+r* hi n t* *4 ■ • ! '*r:- l-~€<
' /h )tl n, */f O - ^ «• *^ V ’V*
• « * -"4
* vW ^
/(sins
9* s.
far V
- £
7 ^
2 /i,
/i/
4ir
- - - -V
J£, v 4>^ ^
J%**—CO & /jt^v%^hr V /&/kys\r wfc%0* 'fa / < /S.1^4 ^f>
^ ■1 < f?X ■ j i i , 1 1^ 1 r9-ir^ ,i ^ ^1 / 'g^ " /4 r -
■sf* d f 4 /VUfry ^
^ fir or^^r
t //*., & / /& // /, — /<&> <4 / /£ // / —^_ / /'/■'
£tiS b#>r>-£*P‘ ^ *
4e^r <y c v ^ (J/t <3£ t*u^?£y&> .p pj
'^ {fr**,* (Z*ld fyct i l 6 Cr£>l&L*^ A< 7^)
ttr --"fah
/L j>\ j*^&i **- u ^ ^ - 4? fQ^tfZ'fy f fiu- f &p* l^f rt *' f t' L C&\~
^ ^ c /< I ^/ft-'f. i. . .- - r^.-V /£^i ^ , Jl-'t-*'££ v ,
^ * H // .<• 4, -V ' P P-- p /}\^s€U>** u cT^ s*t C^/X^h/y rtffp
: - ^ T £V ~4^P ^_f
"7
P/lA *- t > -■£ ^ -' ' *
^ / 7* /£*/«-<. ^
-^•t- / c • .
- c^- fit **t t- ' ^ PA¬
S' ‘ P * c £* /A
v.-/ +
C-C^ <Ap '.<c. ^.t^- ^>'V/rr. ^7
f"*P r y fp * ^ t ^ '
Q iS~ try-fa* &Y f.-l^J P/l t
C J &* € ^ X
^jj^LCi if fj t i tn. f<rt *trP^Sy /** Jf
/te
f^’\ f ^Cr & £rU£?t~^P■■ -V-'
V
v 1 /J_ ^&r. ^ ^4 /*Y *.
- ^ t jV L .y .I'ci-i.'S jj*Vh*~
l' - f <-' \ >>/ A l IgA c * • • -L iHi -r ) ; *^«_
/'7^-tr^^ t ^C_ fl V wt/
1
(?/«
r
/
4^ ^- *
- /•
f /
Ivt^/) till UXL
<1/^ j
/!^<_ / J ' i ‘TcU-^~ If.
-n,\
K*i_ fl
1 (!', i % '-6
I
- ^ /-
/.- (•' < / (f * ^ £ 11 -; -
4
h
ff
} v *
-• '^f. .
^3 •
/ - V *-C' U '; A.
7
( 209 )
SP £ RM A TOR EH £E A *
Definition*
Causes,
Symptoms —1st and 2d stage*
Biagnosis.
Prognosis.
Pis section.
Treatment.
S , Al jH-c ^ -**■* y
3 fir~ s* . *
//i t
4 ,f ,;■ ’ u / ,£ / ^ ^ ^ —*S<SH
*^1 * * ^ V .•’'. ',-e^ • /^Tc^*' **%,+ * r-r? p^**^A * *e m,. '■ 4^ / jfcy-w^
A ■
d+VUir?
***** *i*+*ACt ^
yy■^£* ***££4
^ ^ ^ r «<r3 pfV**- ^ < j m ' 4 ' ^
A^y^W ***.*Jj &#**■*,> ~r €yi *<l> f,^*L * „
A 4f<- £* i ^4 / jf > 1 * <?>t- ^ ^ ^ *sCs (*- y «* C. s\*. _. , ^
j n &£■■ v>tJ “
" • .' ’ /- 1 ** f*'£ 'it* •/. -^ f i
*,t, ^ ^ X y ./ ,. <f t A*
<2jri* / ^t JV 'y y£ t'^/ <- w > y^ <^f ^ >4 ^
* <V X
f - * * ^ *,
J' / f t ^ (?: tZA ^ pi i- **.*, ^<_
A^*' ¥ * lir r^\I >£ y H */j
f-+* *' jc 'i‘‘ v * / # J . /t *- ** c .«•*
_/ ^ T _-
/- S H } ,A.
&~Y c * C< e.)
y £Ky^_ ^ /I u . j
' > * * >/ ,- *3 <, ^.- „ - ^ ——7
A*pr H *»J& /*>c K-r:f A*^' f *'*~'" <- • ^ ^ J £
t \Jj& *
P|R M
■ , tr . .- *■ .. ^ • -t£ .•"-ii^
/C-
/ J
^ -* /*>**> C-+ Cr . ^ rtV -A /* * ■ ^ 1 ^
*? — &dfcnry$ Ar^t-c. v .
* ?U-^4 _ ct±C~ $ **x*jf*4*. ^ ?. , ^
^ y^ r w* * c **- ^ t. #. - ^ - J r
' t - / J ^ ^ ^ ft .y. y C / ^ - Ah*&r~ ftu^ry^
'C/Vr/ ** ^ L /J <* ' «’--/*--■£■ Cw y // y *. //' t A
i^y^'p v 'a A^. <^. (T <f g) £<*%*,£ /%) > ^
VfiS*
^ * ctA Jjt frt r\)j />u
fbix^A fifr*
h&M Tu ttC *'}*
ttt' tCto+r #4 tt
f™* *«,U llr U/Jbcu tKi*v i/*.
FOURTH DIVISION.
if^V
AMPUTATION.
tlCiv* firtv ^
<4^
4i^ta
Timt.
.Place*
Definition,
Import mice* - ri ■' - mr
JiZfcj argr,
Ctej^r#ftW .
1 1, Circular,
ilftf/W#. 1 2. Flap, single and double,
J 3. Oval or oblique.
> L Primary.
£ 2, Consecutive,
i 1. In Continuity of limb,
t 2, In Contiguity of limb,
J 1. Operations of nec^sity,
} 2* Operations of choice or complaisance.
) 1. Operation of necessity,
j 2. Operations of election.
Causes demanding the operation,
Prognosis .—Fa vo rable e ire umsta nces.
1, Youth,
2, Habit somewhat reduced but not too weak.
3, Cheerful temperament,
4, Good general health.
5* Simple disease or accident,
6, Part at some distance from the trunk.
7. The upper extremity.
5, Circumstances of the patient.
Statistics of amputation ,
Preparation of patient.
Instruments required*
Dressings.
t^Yki,
^ au
Circumstance,
Spot*
Accidents.
Accompanying.
i/v f\ f r>%<ec<y*£**+j
'Secondary.
i l. Hemorrhage.
. 2, Excessive pain.
\ 3. Fainting.
4. Convulsion
, Hemorrhage
> I. Hemorrhage,
j 2. Inflammation of stump.
3. Conical stump.
4. Abscess and sinus of stump.
3. Necrosis or carles of bone.
6. Cystitis.
7. Phlebitis.
8. Metastatic abscess.
9. Gangrene.
10. Hectic fever.
Healing of the stump and changes which tale place in the different tissues.
Modification of the constitution ,
1 /t/ruj.
f - iT
J/,»-
Jw*r a*# 2't£^4£t+y~ ^ ~/i, t .r/f?C£o . CK^stf
Af*^ ^7 *-<£ - . v _ /■«
-Utsfao 4^-^ „, ^.K /t<
&*£ ' - /bztitl~*i*-*~ y*^ £ts— s?
^y^uc tt y( ^ 6to^Sc+/s^S.
y?~rrtr>ts?& fi&ju* ~ C4 QJL*^.-/-’
fccLA^^u^i fr it^p •-_
L^cA-C tt<d'( ..-&- j A~£sY
faxes /t^y Jf ^-tstd s<± &/c 'fii.’Jyfc) -
r/ty&j ^ t&siXy
i l 4 >■« *■ <’ *■ ( ' iA "/£ ) ■ <J <£*£. ■ .,' ‘*i ,./ /-.
Al/fr^r, JL+s£- - £*&*+ ft'e?>*-
a*6Ufi /^*/^.y/*; *%«**
/ lK &<~t*j - /2 - /&tzy£-*>'A l*-$i.?. u U-&
■3 — J+fy * * '*+*■ Sl,^,.^*. yt&i > , r -
l^e, 'M'**- — ^ jf-OL iS&Zit /v'.
. l^fitldsu - * C'^ ^ o.£*w-«. X'"^ 1 t - w t ^p-j i^-eL * ,
/!*>*4 04aA^FFF & J?"HsJ) O^sLr /[~&r~
. -' / J ^r_. r ctF^ej M
lMO-^t ti A^rtA/Ct^ xfc
Unrd^ cLc4~ f
* d iL-^
ic fKc^
/C,
( - ^ &J-L**-
&Q ^ ^ tetry^ ~$>yZZ
^Cvjb &i**Yvyis i~~ ^£,<-> GW<~-
farUL tt M^2+ *^y4u4$
/U^L d^' jl £Ls p-L. c-CsO /‘ j .Ct^- 4- ^
4w oftew- v U » ' C<s'XS^-4 '~C, . /
£■' ^ * ^/jvwv '***• jf »~ •
1 ^y C^-/ * (3^. * h^^C-
fr ^ £#'h
■Ksv^siy — \J>CC*CO\st/L* ^cc^. ..0~
/’*- i'S-i. Y^f- <Z^~r>x^ £7^ /sts£c >4C*y <7j ^
vHi./. Cifr-t^.'h ^£h A'fcz -
l*fj\4/b(S / / \siJ~'-- i t^.-J &‘C*' &{.i y 'f'~ &(■*■■*■'
' pisfc i/Cuypc ‘K^W — .y
1 £*?>,■£& — h>£ J*!lr 4t'i^C /nJb- £+tS(
A.w A i . s/
[^yny*’' *■ t ^ '■ *' 5T f~ F *-W<- F--F'
jL*~tyi-4'£t* *
r i^O^C £c/^t4 K
F - • - - v. p w v - /■'•' - ^
". J'e^vT^Xty flriwuir, «ti iW^-'-y ipM&r
IjlfoUgtfK/ UZ'fu L \<Ft'nJrl t) tff mV - ■£
A-/!^ ©''•' prt^U^c i v^iv- ^-{, Vi •*■ fli'Vvi |^,!- \ _>
'V'4 ta &w u4 ’thww^irv
riu
U 1^ kJ-
jkf J c
< ' iv» u J? ~Q_j t r
/£t-
T 6 * /2'W<3^*^ tUvu+~-; Uv *tftft y4v^U^v^A'~ T * / 4xr J
ft &Cu+ft '*" A^ftt' Aa^O' ~- tft^^ft-' CU-ftftft^ ftftftft)
Ol-ttvkmJd Cht-tsy lictH * —’ / ^ - /I Atte^ftTtft fc* &C*t *—
h'tC‘3 &. s'y AftgffL /Ut^O^A. Ju ,t<^ £3?*
^ aft&ft after* ‘ft’ J&ihI <*fcw> 0*&«£ {fai'U,
^ ' jft't/XJ *4£*t"^r? ya+ftu* /*•*&., fji v- ^
£x**Jb ^ ftcc ft ftc> CZ OZcft A-ftt v
&*• ~ Av«*4^Cj Ap /*( , tfc ,
^J-4^ e&cft* ■i-fthti&A in*. ft! s^X’tv fth&t*sfyftt
tt^i ^ 4 jf a*--* *«* ^r)n^ !
Pi*f--A-j ,*%4>+&*.--/ p /*•*.« «. «■*?■**»«./
A 8 ** OsL ftf fj Hi, l
4, ft ft* <5» At Cifn-j^
£>u.p> *J ^fe*- «Aj ftt/io A. l*yft ^CT /6->^.^,uJ
Jt *. ^ L^ P&*4 y«t t{^ i *^> 0uJ
■tAt i \.f*J j-ii A) \ift*.^ t't. * ~*s sifti.ft fti~L &i /ft+A~A -
r kt^tn^t^Q ~ eftZZuV f?*v*£*- ft*) &ftL/3tZT2 ft / ft if
&U ~ft> ..... T Ot/
^ ftlSU*~ **v (ftU&ftAj* ft
7 /< '**■■& l~ aft fufU-l ' '&-<*-g' ^
ftU-&.ft*s<t j AihCet, C i *y b- ftrr ft’ti
4* /ht+^nSlA
**p**-4~~ • H-'ttftC*- ftft?{*t>3 % * !\^|
^ fiftcU. L ptu, /&?/^4ftj
/ /l£*ft,tZj ftt+J Jtj, ftct t tft ft*,+<i,*. e^cft hp^yy —
*+**--& ^ftCft -C** it-£ it - g-tftcl Ct-uft ■*/> ffiifttf.
* '/ . dft&Ci4. £4*w 'ti ;* ^ L flt&. A'-
a^l _ e^n/ Uv^y U ^
fft-ftftj^ UAJ t*$f v&Ia** ^/u%^ ^ /|V^ b (^4^ l
dhy 1 - Afrusv^ftt,^ ftt-4ft*.ftv\ wV>. ^.u^.e
A"U f ^Jt.) llU u) -’•■-■< t'«» Orw/ft-AA' (xh-i ’■ * s
I (/v iv-c u^?> eL^Arv*-s ^iA in Jb*e/~tV
I ’ttuc ,t :$*' l^r° bitdfa* — ^ ct ^‘ /y, fCt-c^
' £*-> • , y\\a+a 4' — ‘yCL*^-fy-C^c 4^“^ l£0^^>i^Uti^
'&£ -r/- ' - - —- / ^ ! ^t-‘ r ~^' /■■£,).
I ^ fn rf-yt.ddj(sL'frt-<i) j_ yr ^y et-+*-y
» l^rei-C Urrt*. i^Uid. ~~ ey ( t?fr
v v :<> <?<fl u-d 4<rt ,o* < ,/iphit* S-au*- tcUi.J /t <^ a XC^~ j' ^
^jfe: - <{’{' ^ C * C> ^ ^■''t t d ‘ (-- t y ^. '
. -. : .<n(/■(.:■;< . / - (Jt?}t*fA /k ujp^c clc&o • >
.< 'A>V?“Z?7.( I - ■A/ 4// L>
I ~ Jjl-U- ;./ ./yuy / ^
s fiL,tp.C ; (f <C:.
. potato
/fK £
tn-C-
^ ,... w
)i^€-d£2 ,'('i*y^} *w hf,? n §/t r?>^~»p «c -.**, #w* /L**
£A*~^f4- «•**■ /rrt±&$ 1>WU>H- t-c, rh<,
f ’ VH c * C"-JL(}* *♦ - 'UlxcsUt-d -
!* eW^>, L ,.,. a.<T~ *
'~ ■:>. pjr^T &**<*>&.£■ '*/
... J&t&fc, /$n^. &, , * _.. /y.,
^ / n t-^' ( ^ /! / 1
* JKW ^
Jheyr>^
r\
\Sh** <~ __ V^-< • {?A T .' ,
A : 4: .*.
?'^** ***■& v*t- £e-+-fc, ^Qg^t.e^ (i • v-; 1 '
^SJ ^ ^ <^_
^ - jfa+T-?c±t J
- >>^4-!.rt~ I ^ J u ^
ff ^ C~ U#»a fa^Jtc
fL$*44fi ^CC 7f\i ykX* * \ w<r /t r /O
'v •' : ■' ' •*<,/*.•
*f Uni- Mjr,, ^u-jfc. aJL*-
ftjitf* 70^4 t& £4t*. *• «*. «^v' ^ t ■ > 4* / /is&t /e -*
&4&**f*t+*\ fir 3' p/l> £'/■<.(h-
T£l b.Jt-t.^ Su & t 34t<- <■ '■'*■-? — LrttPp * fei-~P% ^’/■'ti lv i'
1 - ~?T^ / 7^ rfm%. '
&***■■ .. —
t Qt~ * * J-
* L ^ r t-'***' £&' /k~-J \ *
\ 4+r'fi
L-y ' lt'3t.i<3-d' r . ■:_ * /1 v /< ' •tti i'W ji- S11* 1 »"W i7 ■T ' - ^y~~ 1
1-tH* /. -,J j 1LC -^ligY^fir- rA-Uu i ^ ,
^ /U^-^4 „ /"-Vw &■ -l. f (hv^^r-
'fptAn. J if. $nrt: L i , -y kifiio — Owc^ f^ Ci4 l~v
PA^^p-
^ i - ^Ctluin r.^J
t*A- h--fct.ii, Cy W r <,h ;? ; 4 ;
0U
2
0 C€.
^ 0sj&t> £Z<p
' /j ^7 f
^CC '^7 > t ^
A
z^
/0*r ^ & l> /a* - f
J"J?sO J- ^ £ 2 r
^ ^ £ Zjj^
&nr
7
3*
/2L'2^l<3
/: €i
T
ct
£
aA*
i^ K <T
^ l<+\
(SZt^S^i-^u- ^ -*-v
^r ^/'l/^i' < ^ <2*' &3 f$7~7^f y / $■ / / "* </ ^ *■ ' ■ / //
V 1 /: ^/. ** f? t/2^ i ^
__ _ , <5^ ? /
gZ^^VrP*. H^fl^ $22 ^ ^ fa 1^%^
£%^ i r ~£*r M -0£is^- dP&*-* _ - - y i Z~* *-^+Z ZZ& i w s^A'c-/^ J'
^ /^O-^C- s'/TiJZr
i f * ti/ <2^***'- /c A— *■ x
C-C- , L ;Mi
<C2si.^ -' i4 —
^ A,
/ j !
/J.^/fvy' ^^r ^ jh C**-Z &i~ij & i <
/%+ // p ttf <$**> " (ff- cTi <m-~ I
Z r »' *^*v* -"" ^ -■'/ v ^rZ $ZZL c/Z^^. ^ ^
. ^2P ^ Z^/ A ^j
i^Uyi^^ ££<L^ yO-L^Y^^
/ Q f* £ & jsh? . : %yf*
{C^isif 2 C^k) *rnm- { ( ijCt uti/-^ t (. ^ // 1 V W <■ / ' I
<S &'H^jZl£c $*£& /»t S±{27-1^^ A j / J / S'/ t ^cf ——
<S*JL*hj /tZcZ^ ZZt^dZ'Z'Z d/i ~€^ ^
*^bCs&r 0 £X~&Z~& /*'*-'tZZ^ ^S2'i^>^ d^Zc * ^ s^Cl Z t*-
$^lcL~nrtt±- & ^ta > L& l ' f\L ^ /L-^Z c j
^ v. ^ v L U > Cv t-/?f ^•v-'’- ^ cJ t t ^ Cc o ^- 4 lA^tctC' 1
^Z J \~r/ t ■ " f IsXajk - t&^i4- tly,
i^r\c^o\ct
/ y t-2]^r~Z Jfyt'Ct t^v l f fl^\Q tc^ix^ //^ r v
v Cv^T> r ^tjJ^ ^ ] j / ?T~i> J v^w--^ Qg^>
•^VU
cz>^
( 213 )
CONSIDERATION 1 OF THE DIFFERENT GENERAL METHODS*
1. Circular Amputation.
Hi'story.
Object had in view.
Manner of calculating the flap,
Marnier of dividing the Use nee.
Re version of the flap.
Instruments employed
Ad vantages () f the operation.
Cases to which it is most applicable .
2* Flap Operation.
History,
Object had in view.
Manner of calculating the flap.
Manner of dividing the tissues.
Instruments employed.
Advantages of the operation.
Cases to which it is applicable,
3, Oval Operation.
History,
Object had in view.
Manner of calculating the Jlap.
Maimer of dividing the'tissues.
Instruments employed.
Advantages of the operation.
Cases to which it is considered applicable,
4, Operation in Continuity of Limb.
History .
Object hail imniew.
Manner of dividing the tissues.
Instruments re qnired ►
Advantages of the operation ♦
J} isadv ant ages .
Cases to which it is applicable.
5, Operation In Contiguity of Limb.
History.
Object had in mew.
Manner of dividing the tiss ues.
Instruments required.
Advantages of the operation,
D isadvant ages ,
Cases to which it is applicable.
( 212 )
SPEClAt, AMPUTATIONS*
1. Of the Upper Extremity*
These consist of amputations of the Phalanges, metacarpo-phalangeal articu¬
lations, metacarpal hones, separately or collectively, metacarpo-carpal joints,
radio-carpal articulations, of the fore-arm, el bow-joint, arm, shoulder-joint and
shoulder-blade with the arm, i
2 . Of the Lower Extremity,
These consist of amputations of the Phalanges, metatarso-phalangeal arti¬
culations, metatarso-tarsal, ankle joint, leg, at the knee joint, thigh, and hip
joint.
RESECTION OF BONES-
Definition,
History.
Classificaiio n —»
1. Those practiced in the continuity of a hone.
2. Those practiced in the contiguity*
3* Those in which the hone is extracted entire.
calling for resection* —Caries, necrosis, osteo sarcoma, spina ventosa,
compound and comminuted fractures, gunshot injuries, and compound luxations.
Counter indications*
Prognosis *
Time of performance.
Instruments and apparatus*
Special application.
ft tsrtf- ( L ■*-- 4[ yv 0 C — Sc « $(m> ylct j
•z^m- ^ vAi 4 jjj ,' T j>, j ~ J
Ui/m nsA JL£A**Yc- / X V A/ - C9 k
rJYJ^*^ / Y'/ A/ ~ C -9 h
Y*tp-<~^) f / t >* Y A/pffiC jyC &Yl/<r*^ £l. t > }
^4>*»‘ v'' C'£-&* *- C 4 } <~t. J f^) j|
/Z^*" ^YYY ^cSY 3 vj^: _> *2 <<<>?•
c ftf.6£±4C£ r . ,/■■;. I
jlrifiv* lY^y Lt£i+r fp€*<3 w 2= / ' J fl
W‘ '*^k&\\) i >^V^ ^ YY&Y ■: ,_);~l3ol
« ;:I
J ^ > '
£ 41 $ eu^ /to, 64 c >4 a I
tlC'Jrfot/t ■ .** I
ite"--
j£ "»yW
t
& itC-6
J *k*t
^ Itj AL'Cfa #p C 'fij
(y Y~S tir t /< ^■o r ~ +-
I-4 ,- - _ - ' y>l' "' -' ><jH
jj tvad. (iL l o'-pc. (YhYrvtY L Y^YitCi, Us{_ ScY' i '
ys ^
^-C-Y^-C A*- /H i ^Wurx^ £5,
difi^Cd ^ 2v t y /-s /0-.,.,-,.„, iL
tt-'tYi t d $ Y ^-} /.. £&~Y-c^~ j ■
c^ c^f^Yc YLciS) Gc+t- Y I
^ Ji A
HW ■ Jk ^ i <— C4 f T^/L^
tu?.-h"' fa c*nrt AJ &L, h tr-uAn*
* , -^^Arv ^ ■ ' P^- f. 4 V ** £ J ^~~‘
^ ^ '1 -*~Tsrr - J
. ,rt/: 7'^ -'**■-^
t>*
^jj-^ -■O'./i/'
. _ A /U-»* <^, fJ~£sL>j
~ L&AA ^vC .U -CrzK^. /L^t
tuC- i w /w /L
1 ~7 . /'»
t/lAri ti>>
4,u
5j5 C&A.‘fr &Aj '<4 'thO^^y, *■
j}t,1rr~ (tfu+AX** " { «fjj^3. (X+IrfxLbj —-:-' ""X |
A 'E&’b-u AUAXJ h—CisV /
hy *4..^' T&**-i s u++ ’ja 'A. ct'*- * -&+& — A++~ c. :
$ fiW ^ i £ tU-ly | j
/Lst: UzA-4*^'1^ "
A'-O 1^( V< v 5 L^ts-Z;
\ t &<■+\A /\U-rC"Y ■»
M kpyv^tfr* <?j <? c.A+4 A ^ : t-'t
<yif{r - W* ^ udki-S* *»*Lr} k ; ■**.
i,v) >’y?i C'-fyfKA ^*V /* i,M w/uO —— 'V
e<t ' * V * .^Vlfw iVtvU,-
, • Vfr4' d CtX-^'vLQ . $y/ (i^vn^
vU j'i-H-i"^ i ~> '"ft {),<. # V l-u-tA^I <*-*-/<L.^-c
■ -\ ■ '■■■"'■ ' ■. tfO —
c^' ' ^ £>C-^* *- £- i- 'fa**pp
t -. (- ^ L C ^ *. *- — ^ , Ji ■' ^ 1 ' l.. t S' ^ C^' (' L'"\ "^-'
<V^-irp --
, / - -c
/C - V v -
£4" V ^- r rf/ *
/h~sV
'
/
//
$u»\ S l/svjt sj-t-sjj
ihbitr^^ Huum,4 I >
H I & - 7 m /Sal
fMt*J
///
Stowtui'iu
7
J /// / ,4-
/fomm^y
$£v4%L £,/!()
the ‘Kffir —
fytmtJi&L cY
YhYurU fi fe
j kJ,4c ;'/
» - - r '£'i
| *5 ^4 t d£C_,
ifhxldwteo;
\^u 7 c^(iC£^ t
sh^jicL
Z'A-
jL C ' ^ V-*-* Cr*
r s'
/?3
i />t
ft ^ _ N
. 0 Ji+* y £ —
/ ■^f^r'-’ -•• <'S ^K.(c^ 3 *- f*~ f J*£te*p ^ ^ V^^Jr ^
/V<5*^V £ * J?~P& A'£ C-f* Sj fit- i t~- 3 <£< & 0
Jk \s*£-<s&- *$3 y. ^ 3+^4^^? c yjL[
£ -fan-} t^^LjL a. * < 5 l 6 ) *4£*y * cCc^x, i^£fo y t Jr
Aj.vfJ ^tc+-t^^ 3-f *uJC *tfy}yv^
^Vi
/£-W Gtyv^^A- bt^4~+-* r £>,.,*£**' JS
/lyvi.
f
o# f}<3 ^ & fyy* ±3t-* —-.
^ | *JC » iy? ^-1-t^i/' i-S-'C. h A
|E^/ / ^ -2 *
^ n^U^r^C? Ttt yJ - - * -
hfyy^ c>0^ ■ t. £?- -*
d^O' 1 r* £rU fj >^v (^ * *~v^**^*^o*r * ^
‘* ' ^ &*- L <rt /rw ^ 'M^l i r~y^t/ /■>/> ' >
_
’ $f*f‘ 'rv V<i>££v^ ' ‘ ‘/'w W» % -** ' ^ x5j.
v - . . r J K *
^ *> • ^ «*- # >v
i**#^-** ? *£
/ >v
■ /
r
t U7VH1
iPuCti* 3
mL
^ ^ ^7?u* -L /^<io L*j£L <04 »/ (j prtL y 1
P /i ■«■ - - • ■■■';: ^ — ,;^ i />-4 tt*f.J. { ■
LfhjfpJr fy■ y Cf (& l*-±- f$~0 'S ff +** *f^P*b~,^ H£'
w : - i ; , 4 / -■ ^ X- - ,
bh^tiv^ J ", ^ W r f 1^ (jLi^Ut’t>
■iyu/C'f'i'i ^ iU4,j 'j iv ^‘ : ■•■' '■-->*■• (?C-c^vv i-ciA^— bJ&W,
ib OU vx Lc., *“t\V Jo—■6^. y'V'V”*
ylfS !?Uaa^ '^fLirW-US ViWj, ‘ jhK ^
t*w_ (^i-^yw&u4<->
^£ ' V'* •. *r\~f l, 1 ^ A ;.. ^ fc ' ' V
.Uv-^vv^Wv ' (PcC|^
•*
1 f
1TZP-
Oz
BHiL^ ,f n
w\
^ . - Ail,/**•*''? j j
gj JZ+uU •--) ; 7 ' : n^ a J , 1<€W j
p/0 e /-- f ■*-'* cC — yfayyi+j Itnrfe dhfK.J
JLrru,i ,/wh*.- '/) , ,■■
• ‘' u '*''/''f“*f •"^w 4 .«uc^d &&>■ ikt'** * * *•.:)
d*r~iA A^, jr».
^ / /<T ^ J ' ‘ -
^r. I , ArC«-J —•
- ti _ /y c>-£?/■•- fir
•■;: y 'f*~ ;' x '• ' v -'~ / Y\ £ ) v
J - v ^ '?• >r,t£n u.+» - jsrjt*^kf\ /~'J <
^ V ~ V ' •'*~* ; •"•' 7* • y y rtf^ f
,$r li.r(Y t , U -'l t- t -•- - x, ^ ) t
■ j&Th' d s> p 4-f /* +?
^r*p 40 /***»f - /h ^ Ul^^A
£t>i /, i ■ iud „ -a#.# Jr /., j ~ n* y~ J
*+*■ ~ ***-/£
\L. // flA tfb~
• ^/U
<^i^j
tyyyk kwl: krppj
^■K litnw*' ‘i i'*r
J'Z/'ytriJ &/~b wi- l
(M&jhtMi iti £- k 'Mrt+j ^ Cu p,
: ' . ) 4 >- *= 285 ^- Jb{#4 y
/J U^IA.^ *" <2?V V« ft-ff, ^£2./ *0
V il '(fn-j) .j
b
■ * *
J>S >{ ;v ; .. ■, { !w ,;■■ 0 V
.Cv-v. . /-t, v-^'i f 1 ' '■ v V^W'l-
v. *M
1‘. 1 w' i^V
'
Z>v 'A-U'-iJ-'r'- y t'j U>, (fct**~**\-
\ I — /// / V*
-t- J. q vv'-«v*a. ^ u s -tAu, i^C ( ,> p^p^u
> } / / // V
.(!./» i L yv~ ■ i-vv <j' ■>■{ : u/v-w'! ^u£t>*
/./(l'.' '• \? I' 7''v — ■C+'rVVVVvy-v ••
pg—- - v .. ,,.. - T ^ |L'(‘ 7 vv w y/w
13/Wffc V^r-vi <7* Ak 4 ft ,<jMvta - $ )}/, ( 1
J^/£. •., 'V vj - &* < 3-4AC<t* r v , y '.y^ v i-'lA-t 0
Uvx- - 5 '&-4&*$cs — u^L^yj^j tZ^, y
^yj - f jct-CiX ^/^Ua 4 'Ufyv ^W*7-
* U ’■ 'll ' <9* v t ( yjvyu*^ '
> Y\ rt j O -! £■(.■y ,CA-' "
■
vM~ fUyC'-xC^ yA-vnw ; •> : -7,6L ,
;W*fli ^ Ivd- . Mvwvfj ;V( yvl
^f/$5vC Kw C^J-v^vq j^(U~V ^
jftft. />> c/j
>• . v ¥
- ww~\ *■ ,
•*•'•>#► V -vi' i * f
w .a# .\ ' :•
WJks. i I 1
Live Music
Archive
Librivox
Free Audio
Metropolitan Museum
Cleveland
Museum of Art
Internet
Arcade
Console Living Room
Open Library
American
Libraries
TV News
Understanding
9/11